Surgical system sterile drape

ABSTRACT

A sterile drape, a surgical system with the drape, and a draping method are provided. In one embodiment, a sterile drape includes a plurality of drape pockets, each of the drape pockets including an exterior surface to be adjacent a sterile field for performing a surgical procedure and an interior surface to be adjacent a non-sterile instrument manipulator coupled to a manipulator arm of a robotic surgical system. The drape further includes a plurality of flexible membranes at a distal face of each of the drape pockets for interfacing between outputs of an instrument manipulator and inputs of a respective surgical instrument, and a rotatable seal adapted to couple a proximal opening of each of the drape pockets to a rotatable element at a distal end of the manipulator arm.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.61/334,978 entitled “Surgical System” filed May 14, 2010, the fulldisclosure of which is incorporated by reference herein for allpurposes.

This application is related to U.S. patent application Ser. No.11/762,165, filed Jun. 13, 2007, which is incorporated by referenceherein for all purposes. U.S. patent application Ser. No. 11/762,165claimed the priority benefit of the following United States provisionalpatent applications, all of which are incorporated by reference herein:60/813,028 entitled “Single port system 2” filed Jun. 13, 2006 by Cooperet al.; 60/813,029 entitled “Single port surgical system 1” filed Jun.13, 2006 by Cooper; 60/813,030 entitled “Independently actuated opticaltrain” filed Jun. 13, 2006 by Larkin et al.; 60/813,075 entitled“Modular cannula architecture” filed Jun. 13, 2006 by Larkin et al.;60/813,125 entitled “Methods for delivering instruments to a surgicalsite with minimal disturbance to intermediate structures” filed Jun. 13,2006 by Larkin et al.; 60/813,126 entitled “Rigid single port surgicalsystem” filed Jun. 13, 2006 by Cooper; 60/813,129 entitled “Minimum netforce actuation” filed Jun. 13, 2006 by Cooper et al.; 60/813,131entitled “Side working tools and camera” filed Jun. 13, 2006 by Duval etal.; 60/813,172 entitled “Passing cables through joints” filed Jun. 13,2006 by Cooper; 60/813,173 entitled “Hollow smoothly bending instrumentjoints” filed Jun. 13, 2006 by Larkin et al.; 60/813,198 entitled“Retraction devices and methods” filed Jun. 13, 2006 by Mohr et al.;60/813,207 entitled “Sensory architecture for endoluminal robots” filedJun. 13, 2006 by Diolaiti et al.; and 60/813,328 entitled “Concept forsingle port laparoscopic surgery” filed Jun. 13, 2006 by Mohr et al.

In addition, this application is related to the following pending UnitedStates patent applications, all of which are incorporated by referenceherein: Ser. No. 11/762,217 entitled “Retraction of tissue for singleport entry, robotically assisted medical procedures” by Mohr; Ser. No.11/762,222 entitled “Bracing of bundled medical devices for single portentry, robotically assisted medical procedures” by Mohr et al.; Ser. No.11/762,231 entitled “Extendable suction surface for bracing medicaldevices during robotically assisted medical procedures” by Schena; Ser.No. 11/762,236 entitled “Control system configured to compensate fornon-ideal actuator-to-joint linkage characteristics in a medical roboticsystem” by Diolaiti et al.; Ser. No. 11/762,185 entitled “Surgicalinstrument actuation system” by Cooper et al.; Ser. No. 11/762,172entitled “Surgical instrument actuator” by Cooper et al.; Ser. No.11/762,161 entitled “Minimally invasive surgical instrument advancement”by Larkin et al.; Ser. No. 11/762,158 entitled “Surgical instrumentcontrol and actuation” by Cooper et al.; Ser. No. 11/762,154 entitled“Surgical instrument with parallel motion mechanism” by Cooper; Ser. No.11/762,149 entitled “Minimally invasive surgical apparatus with sideexit instruments” by Larkin; Ser. No. 11/762,170 entitled “Minimallyinvasive surgical apparatus with side exit instruments” by Larkin; Ser.No. 11/762,143 entitled “Minimally invasive surgical instrument system”by Larkin; Ser. No. 11/762,135 entitled “Side looking minimally invasivesurgery instrument assembly” by Cooper et al.; Ser. No. 11/762,132entitled “Side looking minimally invasive surgery instrument assembly”by Cooper et al.; Ser. No. 11/762,127 entitled “Guide tube control ofminimally invasive surgical instruments” by Larkin et al.; Ser. No.11/762,123 entitled “Minimally invasive surgery guide tube” by Larkin etal.; Ser. No. 11/762,120 entitled “Minimally invasive surgery guidetube” by Larkin et al.; Ser. No. 11/762,118 entitled “Minimally invasivesurgical retractor system” by Larkin; Ser. No. 11/762,114 entitled“Minimally invasive surgical illumination” by Schena et al.; Ser. No.11/762,110 entitled “Retrograde instrument” by Duval et al.; Ser. No.11/762,204 entitled “Retrograde instrument” by Duval et al.; Ser. No.11/762,202 entitled “Preventing instrument/tissue collisions” by Larkin;Ser. No. 11/762,189 entitled “Minimally invasive surgery instrumentassembly with reduced cross section” by Larkin et al.; Ser. No.11/762,191 entitled “Minimally invasive surgical system” by Larkin etal.; Ser. No. 11/762,196 entitled “Minimally invasive surgical system”by Duval et al.; and Ser. No. 11/762,200 entitled “Minimally invasivesurgical system” by Diolaiti.

This application is also related to the following United States patentapplications, all of which are incorporated by reference herein: Ser.No. 12/163,051 (filed Jun. 27, 2008; entitled “Medical Robotic Systemwith Image Referenced Camera Control Using Partitionable Orientation andTranslational Modes”); Ser. No. 12/163,069 (filed Jun. 27, 2008;entitled “Medical Robotic System Having Entry Guide Controller withInstrument Tip Velocity Limiting”); Ser. No. 12/494,695 (filed Jun. 30,2009; entitled “Control of Medical Robotic System Manipulator AboutKinematic Singularities”); Ser. No. 12/541,913 (filed Aug. 15, 2009;entitled “Smooth Control of an Articulated Instrument Across Areas withDifferent Work Space Conditions”); Ser. No. 12/571,675 (filed Oct. 1,2009; entitled “Laterally Fenestrated Cannula”); Ser. No. 12/613,328(filed Nov. 5, 2009; entitled “Controller Assisted Reconfiguration of anArticulated Instrument During Movement Into and Out Of an Entry Guide”);Ser. No. 12/645,391 (filed Dec. 22, 2009; entitled “Instrument Wristwith Cycloidal Surfaces”); Ser. No. 12/702,200 (filed Feb. 8, 2010;entitled “Direct Pull Surgical Gripper”); Ser. No. 12/704,669 (filedFeb. 12, 2010; entitled “Medical Robotic System Providing SensoryFeedback Indicating a Difference Between a Commanded State and aPreferred Pose of an Articulated Instrument”); Ser. No. 12/163,087(filed Jun. 27, 2008; entitled “Medical Robotic System Providing anAuxiliary View of Articulatable Instruments Extending Out Of a DistalEnd of an Entry Guide”); Ser. No. 12/780,071 (filed May 14, 2010;entitled “Medical Robotic System with Coupled Control Modes”); Ser. No.12/780,747 (filed May 14, 2010; entitled “Cable Re-ordering Device”);Ser. No. 12/780,758 (filed May 14, 2010; entitled “Force Transmissionfor Robotic Surgical Instrument”); Ser. No. 12/780,773 (filed May 14,2010; entitled “Overforce Protection Mechanism”); Ser. No. 12/832,580(filed Jul. 8, 2010; entitled “Sheaths for Jointed Instruments”); U.S.patent application Ser. No. ______ (filed ______; entitled “SurgicalSystem Instrument Mounting” (Attorney Docket No. ISRG02440/US)); U.S.patent application Ser. No. ______ (filed ______; entitled “SurgicalSystem Entry Guide” (Attorney Docket No. ISRG02450/US)); U.S. patentapplication Ser. No. ______ (filed ______; entitled “Surgical SystemInstrument Manipulator” (Attorney Docket No. ISRG02460/US)); U.S. patentapplication Ser. No. ______ (filed ______; entitled “Surgical SystemArchitecture” (Attorney Docket No. ISRG02550/US)); U.S. patentapplication Ser. No. ______ (filed ______; entitled “Surgical SystemCounterbalance” (Attorney Docket No. ISRG02560/US)); and U.S. patentapplication Ser. No. ______ (filed ______; entitled “Surgical SystemInstrument Sterile Adapter” (Attorney Docket No. ISRG02820/US)).

BACKGROUND

In robotically-assisted or telerobotic surgery, the surgeon typicallyoperates a master controller to remotely control the motion of surgicalinstruments at the surgical site from a location that may be remote fromthe patient (e.g., across the operating room, in a different room or acompletely different building from the patient). The master controllerusually includes one or more hand input devices, such as joysticks,exoskeletal gloves or the like, which are coupled to the surgicalinstruments with servo motors for articulating the instruments at thesurgical site. The servo motors are typically part of anelectromechanical device or surgical manipulator (“the slave”) thatsupports and controls the surgical instruments that have been introduceddirectly into an open surgical site or through trocar sleeves into abody cavity, such as the patient's abdomen. During the operation, thesurgical manipulator provides mechanical articulation and control of avariety of surgical instruments, such as tissue graspers, needledrivers, electrosurgical cautery probes, etc., that each performsvarious functions for the surgeon, e.g., holding or driving a needle,grasping a blood vessel, or dissecting, cauterizing or coagulatingtissue.

The number of degrees of freedom (DOFs) is the number of independentvariables that uniquely identify the pose/configuration of a teleroboticsystem. Since robotic manipulators are kinematic chains that map the(input) joint space into the (output) Cartesian space, the notion of DOFcan be expressed in any of these two spaces. In particular, the set ofjoint DOFs is the set of joint variables for all the independentlycontrolled joints. Without loss of generality, joints are mechanismsthat provide, e.g., a single translational (prismatic joints) orrotational (revolute joints) DOF. Any mechanism that provides more thanone DOF motion is considered, from a kinematic modeling perspective, astwo or more separate joints. The set of Cartesian DOFs is usuallyrepresented by the three translational (position) variables (e.g.,surge, heave, sway) and by the three rotational (orientation) variables(e.g. Euler angles or roll/pitch/yaw angles) that describe the positionand orientation of an end effector (or tip) frame with respect to agiven reference Cartesian frame.

For example, a planar mechanism with an end effector mounted on twoindependent and perpendicular rails has the capability of controllingthe x/y position within the area spanned by the two rails (prismaticDOFs). If the end effector can be rotated around an axis perpendicularto the plane of the rails, there are then three input DOFs (the two railpositions and the yaw angle) that correspond to three output DOFs (thex/y position and the orientation angle of the end effector).

Although the number of non-redundant Cartesian DOFs that describe a bodywithin a Cartesian reference frame, in which all the translational andorientational variables are independently controlled, can be six, thenumber of joint DOFs is generally the result of design choices thatinvolve considerations of the complexity of the mechanism and the taskspecifications. Accordingly, the number of joint DOFs can be more than,equal to, or less than six. For non-redundant kinematic chains, thenumber of independently controlled joints is equal to the degree ofmobility for the end effector frame. For a certain number of prismaticand revolute joint DOFs, the end effector frame will have an equalnumber of DOFs (except when in singular configurations) in Cartesianspace that will correspond to a combination of translational (x/y/zposition) and rotational (roll/pitch/yaw orientation angle) motions.

The distinction between the input and the output DOFs is extremelyimportant in situations with redundant or “defective” kinematic chains(e.g., mechanical manipulators). In particular, “defective” manipulatorshave fewer than six independently controlled joints and therefore do nothave the capability of fully controlling end effector position andorientation. Instead, defective manipulators are limited to controllingonly a subset of the position and orientation variables. On the otherhand, redundant manipulators have more than six joint DOFs. Thus, aredundant manipulator can use more than one joint configuration toestablish a desired 6-DOF end effector pose. In other words, additionaldegrees of freedom can be used to control not just the end effectorposition and orientation but also the “shape” of the manipulator itself.In addition to the kinematic degrees of freedom, mechanisms may haveother DOFs, such as the pivoting lever movement of gripping jaws orscissors blades.

Telerobotic surgery through remote manipulation has been able to reducethe size and number of incisions required in surgery to enhance patientrecovery while also helping to reduce patient trauma and discomfort.However, telerobotic surgery has also created many new challenges.Robotic manipulators adjacent the patient have made patient accesssometimes difficult for patient-side staff, and for robots designedparticularly for single port surgery, access to the single port is ofvital importance. For example, a surgeon will typically employ a largenumber of different surgical instruments/tools during a procedure andease of access to the manipulator and single port and ease of instrumentexchange are highly desirable.

Another challenge results from the fact that a portion of theelectromechanical surgical manipulator will be positioned adjacent theoperation site. Accordingly, the surgical manipulator may becomecontaminated during surgery and is typically disposed of or sterilizedbetween operations. From a cost perspective, it would be preferable tosterilize the device. However, the servo motors, sensors, encoders, andelectrical connections that are necessary to robotically control themotors typically cannot be sterilized using conventional methods, e.g.,steam, heat and pressure, or chemicals, because the system parts wouldbe damaged or destroyed in the sterilization process.

A sterile drape has been previously used to cover the surgicalmanipulator and has previously included holes through which an adaptor(for example a wrist unit adaptor or a cannula adaptor) would enter thesterile field. However, this disadvantageously requires detachment andsterilization of the adaptors after each procedure and also causes agreater likelihood of contamination through the holes in the drape.

Furthermore, with current sterile drape designs for multi-arm surgicalrobotic systems, each individual arm of the system is draped, but suchdesigns are not applicable for a single port system, in particular whenall the instrument actuators are moved together by a single slavemanipulator.

What is needed, therefore, are improved telerobotic systems, apparatus,and methods for remotely controlling surgical instruments at a surgicalsite on a patient. In particular, these systems, apparatus, and methodsshould be configured to minimize the need for sterilization to improvecost efficiency while also protecting the system and the surgicalpatient. In addition, these systems, apparatus, and methods should bedesigned to minimize instrument exchange time and difficulty during thesurgical procedure while offering an accurate interface between theinstrument and the manipulator. Furthermore, these systems and apparatusshould be configured to minimize form factor so as to provide the mostavailable space around the entry port for surgical staff while alsoproviding for improved range of motion. Furthermore, these systems,apparatus, and methods should provide for organizing, supporting, andefficiently operating multiple instruments through a single port whilereducing collisions between instruments and other apparatus.

SUMMARY

The present disclosure provides improved surgical systems, apparatus,and methods for telerobotic surgery. According to one aspect, a system,apparatus, and method provide at least one telemanipulated surgicalinstrument at a distal end of a draped instrument manipulator andmanipulator arm with an accurate and robust interface while alsoproviding for ease of instrument exchange and enhanced instrumentmanipulation, each surgical instrument working independently of theother and each having an end effector with at least six activelycontrolled degrees of freedom in Cartesian space (i.e., surge, heave,sway, roll, pitch, yaw).

In one embodiment, a sterile drape includes a plurality of drapepockets, each of the drape pockets including an exterior surface to beadjacent a sterile field for performing a surgical procedure and aninterior surface to be adjacent a non-sterile instrument manipulatorcoupled to a manipulator arm of a robotic surgical system. The drapefurther includes a plurality of flexible membranes at a distal face ofeach of the drape pockets for interfacing between outputs of aninstrument manipulator and inputs of a respective surgical instrument,and a rotatable seal adapted to couple a proximal opening of each of thedrape pockets to a rotatable element at a distal end of the manipulatorarm.

In another embodiment, a robotic surgical system for performing aprocedure within a sterile field includes a manipulator arm including aninstrument manipulator in a non-sterile field, a surgical instrument inthe sterile field, and a sterile drape covering the manipulator arm toshield the manipulator arm from the sterile field, the sterile drapeincluding elements as described above.

In yet another embodiment, a method of draping a manipulator arm of arobotic surgical system with a sterile drape includes positioning aflexible membrane of the sterile drape adjacent to an output at a distalend of an instrument manipulator, and draping the instrument manipulatorfrom the distal end of the instrument manipulator to a proximal end ofthe instrument manipulator with a drape pocket of the sterile drape. Themethod further includes coupling a rotatable seal of the sterile drapeto a frame of the manipulator arm and to a rotatable base plate of themanipulator arm, and draping the remaining parts of the manipulator armfrom a distal end of the manipulator arm to a proximal end of themanipulator arm.

A more complete understanding of embodiments of the present disclosurewill be afforded to those skilled in the art, as well as a realizationof additional advantages thereof, by a consideration of the followingdetailed description of one or more embodiments. Reference will be madeto the appended sheets of drawings that will first be described briefly.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B illustrate schematic views of a patient side supportassembly in a telesurgical system with and without a sterile drape,respectively, in accordance with an embodiment of the presentdisclosure.

FIG. 2A is a diagrammatic perspective view that illustrates anembodiment of a telesurgical system with a sterile drape and mountedinstruments.

FIGS. 2B and 2C illustrate side and top views, respectively, of thetelesurgical system of FIG. 2A without a sterile drape being shown.

FIG. 3 is a perspective view that illustrates an embodiment of amanipulator base platform, cluster of instrument manipulators, andmounted instruments.

FIGS. 4A and 4B illustrate perspective views of an instrumentmanipulator extended and retracted, respectively, along an insertionaxis.

FIGS. 5A-1 and 5B-1 illustrate operation of support hooks to couple aproximal face of an instrument transmission mechanism to a distal faceof the instrument manipulator, and FIGS. 5A-2 and 5B-2 illustratesectional views of FIGS. 5A1 and 5B1, respectively.

FIGS. 5C-1 through 5C-4 illustrate different views of the instrumentmanipulator without an outer housing.

FIGS. 6A-6B illustrate different views of a grip module of theinstrument manipulator in accordance with an embodiment of the presentdisclosure.

FIG. 7A illustrates a view of a gimbal actuator module of the instrumentmanipulator in accordance with an embodiment of the present disclosure.

FIG. 7B illustrates a view of a roll module of the instrumentmanipulator in accordance with an embodiment of the present disclosure.

FIG. 8 illustrates a view of a telescopic insertion axis of theinstrument manipulator in accordance with an embodiment of the presentdisclosure.

FIGS. 9A and 9B illustrate perspective views of a proximal portion and adistal portion, respectively, of an instrument configured to mount to aninstrument manipulator.

FIG. 10 illustrates a sectional diagram of an instrument manipulatoroperably coupled to an instrument in accordance with an embodiment ofthe present disclosure.

FIGS. 11A-11B illustrate perspective views of a portion of a steriledrape in a retracted state and an extended state, respectively, inaccordance with an embodiment of the present disclosure.

FIG. 11C illustrates a sectional view of a rotating sterile drapeportion mounted to a distal end of a manipulator arm including a baseplatform in accordance with an embodiment of the present disclosure.

FIG. 11D illustrates an extended sterile drape in accordance with anembodiment of the present disclosure.

FIG. 12 illustrates a perspective view of a portion of an extendedsterile drape including a sterile adapter in accordance with anembodiment of the present disclosure.

FIGS. 13A and 13B illustrate a perspective view of an assembled sterileadapter and an exploded view of the sterile adapter, respectively, inaccordance with an embodiment of the present disclosure.

FIG. 13C illustrates an enlarged view of a roll actuator interface inaccordance with an embodiment of the present disclosure.

FIGS. 14A and 14B illustrate a bottom perspective view and a bottom viewof an instrument manipulator in accordance with an embodiment of thepresent disclosure.

FIG. 15 illustrates a bottom perspective view of the instrumentmanipulator operably coupled to the sterile adapter in accordance withan embodiment of the present disclosure.

FIGS. 16A-16E illustrate a sequence for coupling the instrumentmanipulator and the sterile adapter in accordance with an embodiment ofthe present disclosure.

FIGS. 17A-17C illustrate a sequence for coupling a surgical instrumentto the sterile adapter in accordance with an embodiment of the presentdisclosure.

FIGS. 18A and 18B illustrate an enlarged perspective view and side view,respectively, of the instrument and sterile adapter prior to engagement.

FIGS. 19A and 19B illustrate perspective views of a movable cannulamount in a retracted position and a deployed position, respectively.

FIGS. 20A and 20B illustrate a front and a back perspective view of acannula mounted on a cannula clamp in accordance with an embodiment.

FIG. 21 illustrates a perspective view of a cannula alone.

FIG. 22 illustrates a cross-sectional view of the cannula of FIG. 21 anda mounted entry guide of FIGS. 23A and 23B in combination withinstruments mounted to instrument manipulators on a manipulator platformin accordance with an embodiment of the present disclosure.

FIGS. 23A and 23B illustrate a perspective view and a top view of theentry guide of FIG. 22.

FIG. 24 illustrates a cross-sectional view of another cannula andanother mounted entry guide in combination with instruments mounted toinstrument manipulators on a manipulator platform in accordance with anembodiment of the present disclosure.

FIGS. 24A-24B illustrate perspective views of another movable cannulamounting arm in a retracted position and a deployed position,respectively.

FIG. 24C illustrates a proximal top section of a cannula in accordancewith another embodiment.

FIG. 24D illustrates a cannula clamp at a distal end of a cannulamounting arm in accordance with another embodiment.

FIGS. 25A-25C, 26A-26C, and 27A-27C illustrate different views of asurgical system with an instrument manipulator assembly roll axis orinstrument insertion axis pointed in different directions.

FIG. 28 is a diagrammatic view of a centralized motion control systemfor a minimally invasive telesurgical system in accordance with anembodiment.

FIG. 29 is a diagrammatic view of a distributed motion control systemfor a minimally invasive telesurgical system in accordance with anembodiment.

FIGS. 30A-30B illustrate different views of a counterbalancing link of arobotic surgical system in accordance with an embodiment.

FIG. 31 illustrates a view of the counterbalancing link without anexterior housing in accordance with an embodiment.

FIGS. 32A and 32B illustrate a bottom perspective view and a sectionalview, respectively, of a distal portion of the counterbalancing link inaccordance with an embodiment.

FIG. 33 illustrates a side view of the distal portion of thecounterbalancing link without an end plug, FIG. 34 illustrates anenlarged perspective view of the end plug linear guide, and FIG. 35illustrates a perspective view of an adjustment pin in accordance withvarious aspects of the present disclosure.

FIG. 36A-36C illustrate sectional side views showing a range of movementof the adjustment pin to move an end plug relative to the linear guidein accordance with various aspects of the present disclosure.

FIGS. 37A-37C illustrate detailed views from a distal end of thecounterbalancing proximal link according to various aspects of thepresent disclosure.

Embodiments of the present disclosure and their advantages are bestunderstood by referring to the detailed description that follows. Itshould be appreciated that like reference numerals are used to identifylike elements illustrated in one or more of the figures. It should alsobe appreciated that the figures may not be necessarily drawn to scale.

DETAILED DESCRIPTION

This description and the accompanying drawings that illustrate aspectsand embodiments of the present disclosure should not be taken aslimiting. Various mechanical, compositional, structural, electrical, andoperational changes may be made without departing from the spirit andscope of this description. In some instances, well-known circuits,structures, and techniques have not been shown in detail in order not toobscure the disclosure. Like numbers in two or more figures representthe same or similar elements.

Further, this description's terminology is not intended to limit thedisclosure. For example, spatially relative terms, such as “beneath”,“below”, “lower”, “above”, “upper” “proximal”, “distal”, and the like,may be used to describe one element's or feature's relationship toanother element or feature as illustrated in the figures. Thesespatially relative terms are intended to encompass different positionsand orientations of the device in use or operation in addition to theposition and orientation shown in the figures. For example, if thedevice in the figures is turned over, elements described as “below” or“beneath” other elements or features would then be “above” or “over” theother elements or features. Thus, the exemplary term “below” canencompass both positions and orientations of above and below. The devicemay be otherwise oriented (rotated 90 degrees or at other orientations),and the spatially relative descriptors used herein interpretedaccordingly. Likewise, descriptions of movement along and around variousaxes include various special device positions and orientations. Inaddition, the singular forms “a”, “an”, and “the” are intended toinclude the plural forms as well, unless the context indicatesotherwise. And, the terms “comprises”, “comprising”, “includes”, and thelike specify the presence of stated features, steps, operations,elements, and/or components but do not preclude the presence or additionof one or more other features, steps, operations, elements, components,and/or groups. Components described as coupled may be electrically ormechanically directly coupled, or they may be indirectly coupled via oneor more intermediate components.

In one example, the terms “proximal” or “proximally” are used in ageneral way to describe an object or element which is closer to amanipulator arm base along a kinematic chain of system movement orfarther away from a remote center of motion (or a surgical site) alongthe kinematic chain of system movement. Similarly, the terms “distal” or“distally” are used in a general way to describe an object or elementwhich is farther away from the manipulator arm base along the kinematicchain of system movement or closer to the remote center of motion (or asurgical site) along the kinematic chain of system movement.

The use of an operator's inputs at a master device to control a roboticslave device and perform work at a work site is well known. Such systemsare called various names, such as teleoperation, telemanipulation, ortelerobotic systems. One type of telemanipulation system gives theoperator a perception of being present at the work site, and suchsystems are called, for example, telepresence systems. The da Vinci®Surgical System, commercialized by Intuitive Surgical, Inc. ofSunnyvale, Calif., is an example of a telemanipulation system withtelepresence. Telepresence fundamentals for such a surgical system aredisclosed in U.S. Pat. No. 6,574,355 (filed Mar. 21, 2001), which isincorporated herein by reference. A teleoperated surgical system (withor without a telepresence feature) may be referred to as a telesurgicalsystem.

To avoid repetition in the figures and the descriptions below of thevarious aspects and illustrative embodiments, it should be understoodthat many features are common to many aspects and embodiments. Omissionof an aspect from a description or figure does not imply that the aspectis missing from embodiments that incorporate that aspect. Instead, theaspect may have been omitted for clarity and to avoid prolixdescription. Accordingly, aspects described with reference to onedepicted and/or described embodiment may be present with or applied toother depicted and/or described embodiments unless it is impractical todo so.

Accordingly, several general aspects apply to various descriptionsbelow. Various surgical instruments, guide tubes, and instrumentassemblies are applicable in the present disclosure and are furtherdescribed in U.S. patent application Ser. No. 11/762,165 (filed Jun. 13,2007; U.S. Patent Application Pub. No. US 2008/0065105 A1), which isincorporated herein by reference. Surgical instruments alone, orassemblies including guide tubes, multiple instruments, and/or multipleguide tubes, are applicable in the present disclosure. Therefore,various surgical instruments may be utilized, each surgical instrumentworking independently of the other, and each having an end effector. Insome instances the end effectors operate with at least six activelycontrolled DOFs in Cartesian space (i.e., surge, heave, sway, roll,pitch, yaw), via a single entry port in a patient. One or moreadditional end effector DOFs may apply to, e.g., end effector jawmovement in gripping or shearing instruments.

For example, at least one surgical end effector is shown or described invarious figures. An end effector is the part of the minimally invasivesurgical instrument or assembly that performs a specific surgicalfunction (e.g., forceps/graspers, needle drivers, scissors,electrocautery hooks, staplers, clip appliers/removers, etc.). Many endeffectors themselves have a single DOF (e.g., graspers that open andclose). The end effector may be coupled to the surgical instrument bodywith a mechanism that provides one or more additional DOFs, such as“wrist” type mechanisms. Examples of such mechanisms are shown in U.S.Pat. No. 6,371,952 (filed Jun. 28, 1999; Madhani et al.) and in U.S.Pat. No. 6,817,974 (filed Jun. 28, 2002; Cooper et al.), both of whichare incorporated by reference herein, and may be known as variousIntuitive Surgical, Inc. Endowrist® mechanisms as used on both 8 mm and5 mm instruments for da Vinci® Surgical Systems. Although the surgicalinstruments described herein generally include end effectors, it shouldbe understood that in some aspects an end effector may be omitted. Forexample, the blunt distal tip of an instrument body shaft may be used toretract tissue. As another example, suction or irrigation openings mayexist at the distal tip of a body shaft or the wrist mechanism. In theseaspects, it should be understood that descriptions of positioning andorienting an end effector include positioning and orienting the tip of asurgical instrument that does not have an end effector. For example, adescription that addresses the reference frame for a tip of an endeffector should also be read to include the reference frame of a tip ofa surgical instrument that does not have an end effector.

Throughout this description, it should be understood that a mono orstereoscopic imaging system/image capture component/camera device may beplaced at the distal end of an instrument wherever an end effector isshown or described (the device may be considered a “camera instrument”),or it may be placed near or at the distal end of any guide tube or otherinstrument assembly element. Accordingly, the terms “imaging system” andthe like as used herein should be broadly construed to include bothimage capture components and combinations of image capture componentswith associated circuitry and hardware, within the context of theaspects and embodiments being described. Such endoscopic imaging systems(e.g., optical, infrared, ultrasound, etc.) include systems withdistally positioned image sensing chips and associated circuits thatrelay captured image data via a wired or wireless connection to outsidethe body. Such endoscopic imaging systems also include systems thatrelay images for capture outside the body (e.g., by using rod lenses orfiber optics). In some instruments or instrument assemblies a directview optical system (the endoscopic image is viewed directly at aneyepiece) may be used. An example of a distally positioned semiconductorstereoscopic imaging system is described in U.S. patent application Ser.No. 11/614,661 (filed Dec. 21, 2006; disclosing “StereoscopicEndoscope”; Shafer et al.), which is incorporated by reference.Well-known endoscopic imaging system components, such as electrical andfiber optic illumination connections, are omitted or symbolicallyrepresented for clarity. Illumination for endoscopic imaging istypically represented in the drawings by a single illumination port. Itshould be understood that these depictions are exemplary. The sizes,positions, and numbers of illumination ports may vary. Illuminationports are typically arranged on multiple sides of the imaging apertures,or completely surrounding the imaging apertures, to minimize deepshadows.

In this description, cannulas are typically used to prevent a surgicalinstrument or guide tube from rubbing on patient tissue. Cannulas may beused for both incisions and natural orifices. For situations in which aninstrument or guide tube does not frequently translate or rotaterelative to its insertion (longitudinal) axis, a cannula may not beused. For situations that require insufflation, the cannula may includea seal to prevent excess insufflation gas leakage past the instrument orguide tube. Examples of cannula assemblies which support insufflationand procedures requiring insufflation gas at the surgical site may befound in U.S. patent application Ser. No. 12/705,439 (filed Feb. 12,2010; disclosing “Entry Guide for Multiple Instruments in a Single PortSystem”), the full disclosure of which is incorporated by referenceherein for all purposes. For thoracic surgery that does not requireinsufflation, the cannula seal may be omitted, and if instruments orguide tube insertion axis movement is minimal, then the cannula itselfmay be omitted. A rigid guide tube may function as a cannula in someconfigurations for instruments that are inserted relative to the guidetube. Cannulas and guide tubes may be, e.g., steel or extruded plastic.Plastic, which is less expensive than steel, may be suitable forone-time use.

Various instances and assemblies of flexible surgical instruments andguide tubes are shown and described in U.S. patent application Ser. No.11/762,165, cited above. Such flexibility, in this description, isachieved in various ways. For example, a segment of an instrument orguide tube may be a continuously curving flexible structure, such as onebased on a helical wound coil or on tubes with various segments removed(e.g., kerf-type cuts). Or, the flexible part may be made of a series ofshort, pivotally connected segments (“vertebrae”) that provide asnake-like approximation of a continuously curving structure. Instrumentand guide tube structures may include those in U.S. Patent ApplicationPub. No. US 2004/0138700 (filed Dec. 2, 2003; Cooper et al.), which isincorporated by reference herein. For clarity, the figures andassociated descriptions generally show only two segments of instrumentsand guide tubes, termed proximal (closer to the transmission mechanism;farther from the surgical site) and distal (farther from thetransmission mechanism; closer to the surgical site). It should beunderstood that the instruments and guide tubes may be divided intothree or more segments, each segment being rigid, passively flexible, oractively flexible. Flexing and bending as described for a distalsegment, a proximal segment, or an entire mechanism also apply tointermediate segments that have been omitted for clarity. For instance,an intermediate segment between proximal and distal segments may bend ina simple or compound curve. Flexible segments may be various lengths.Segments with a smaller outside diameter may have a smaller minimumradius of curvature while bending than segments with a larger outsidediameter. For cable-controlled systems, unacceptably high cable frictionor binding limits minimum radius of curvature and the total bend anglewhile bending. The guide tube's (or any joint's) minimum bend radius issuch that it does not kink or otherwise inhibit the smooth motion of theinner surgical instrument's mechanism. Flexible components may be, forexample, up to approximately four feet in length and approximately 0.6inches in diameter. Other lengths and diameters (e.g., shorter, smaller)and the degree of flexibility for a specific mechanism may be determinedby the target anatomy for which the mechanism has been designed.

In some instances only a distal segment of an instrument or guide tubeis flexible, and the proximal segment is rigid. In other instances, theentire segment of the instrument or guide tube that is inside thepatient is flexible. In still other instances, an extreme distal segmentmay be rigid, and one or more other proximal segments are flexible. Theflexible segments may be passive or they may be actively controllable(“steerable”). Such active control may be done using, for example, setsof opposing cables (e.g., one set controlling “pitch” and an orthogonalset controlling “yaw”; three cables can be used to perform similaraction). Other control elements such as small electric or magneticactuators, shape memory alloys, electroactive polymers (“artificialmuscle”), pneumatic or hydraulic bellows or pistons, and the like may beused. In instances in which a segment of an instrument or guide tube isfully or partially inside another guide tube, various combinations ofpassive and active flexibility may exist. For instance, an activelyflexible instrument inside a passively flexible guide tube may exertsufficient lateral force to flex the surrounding guide tube. Similarly,an actively flexible guide tube may flex a passively flexible instrumentinside it. Actively flexible segments of guide tubes and instruments maywork in concert. For both flexible and rigid instruments and guidetubes, control cables placed farther from the center longitudinal axismay provide a mechanical advantage over cables placed nearer to thecenter longitudinal axis, depending on compliance considerations in thevarious designs.

The flexible segment's compliance (stiffness) may vary from being almostcompletely flaccid (small internal frictions exist) to beingsubstantially rigid. In some aspects, the compliance is controllable.For example, a segment or all of a flexible segment of an instrument orguide tube can be made substantially (i.e., effectively but notinfinitely) rigid (the segment is “rigidizable” or “lockable”). Thelockable segment may be locked in a straight, simple curve or in acompound curve shape. Locking may be accomplished by applying tension toone or more cables that run longitudinally along the instrument or guidetube that is sufficient to cause friction to prevent adjacent vertebraefrom moving. The cable or cables may run through a large, central holein each vertebra or may run through smaller holes near the vertebra'souter circumference. Alternatively, the drive element of one or moremotors that move one or more control cables may be soft-locked inposition (e.g., by servocontrol) to hold the cables in position andthereby prevent instrument or guide tube movement, thus locking thevertebrae in place. Keeping a motor drive element in place may be doneto effectively keep other movable instrument and guide tube componentsin place as well. It should be understood that the stiffness underservocontrol, although effective, is generally less than the stiffnessthat may be obtained with braking placed directly on joints, such as thebraking used to keep passive setup joints in place. Cable stiffnessgenerally dominates because it is generally less than servo system orbraked joint stiffness.

In some situations, the compliance of the flexible segment may becontinuously varied between flaccid and rigid states. For example,locking cable tension can be increased to increase stiffness but withoutlocking the flexible segment in a rigid state. Such intermediatecompliance may allow for telesurgical operation while reducing tissuetrauma that may occur due to movements caused by reactive forces fromthe surgical site. Suitable bend sensors incorporated into the flexiblesegment allow the telesurgical system to determine instrument and/orguide tube position as it bends. U.S. Patent Application Pub. No. US2006/0013523 (filed Jul. 13, 2005; Childers et al.), which isincorporated by reference herein, discloses a fiber optic position shapesensing device and method. U.S. patent application Ser. No. 11/491,384(filed Jul. 20, 2006; Larkin et al.), which is incorporated by referenceherein, discloses fiber optic bend sensors (e.g., fiber Bragg gratings)used in the control of such segments and flexible devices.

A surgeon's inputs to control aspects of the minimally invasive surgicalinstrument assemblies, instruments, end effectors, and manipulator armconfiguration as described herein are generally done using an intuitive,camera-referenced control interface. For example, the da Vinci® SurgicalSystem includes a surgeon's console with such a control interface, whichmay be modified to control aspects described herein. The surgeonmanipulates one or more master manual input mechanisms having, e.g., 6DOFs to control the slave instrument assembly and instrument. The inputmechanisms include a finger-operated grasper to control one or more endeffector DOFs (e.g., closing grasping jaws). Intuitive control isprovided by orienting the relative positions of the end effectors andthe endoscopic imaging system with the positions of the surgeon's inputmechanisms and image output display. This orientation allows the surgeonto manipulate the input mechanisms and end effector controls as ifviewing the surgical work site in substantially true presence. Thisteleoperation true presence means that the surgeon views an image from aperspective that appears to be that of an operator directly viewing andworking at the surgical site. U.S. Pat. No. 6,671,581 (filed Jun. 5,2002; Niemeyer et al.), which is incorporated by reference, containsfurther information on camera referenced control in a minimally invasivesurgical apparatus.

Single Port Surgical System

Referring now to FIGS. 1A and 1B, schematic side and front views areshown that illustrate aspects of a robot-assisted (telemanipulative)minimally invasive surgical system that uses aspects of the minimallyinvasive surgical instruments, instrument assemblies, and manipulationand control systems described herein. The three main components are anendoscopic imaging system 102, a surgeon's console 104 (master), and apatient side support system 100 (slave), all interconnected by wired(electrical or optical) or wireless connections 106 as shown. One ormore electronic data processors may be variously located in these maincomponents to provide system functionality. Examples are disclosed inU.S. patent application Ser. No. 11/762,165, cited above. A steriledrape 1000, shown in dotted line, advantageously drapes at least aportion of the patient side support system 100 to maintain a sterilefield during a surgical procedure while also providing for efficient andsimple instrument exchange in conjunction with an accurate interfacebetween the instrument and its associated manipulator.

Imaging system 102 performs image processing functions on, e.g.,captured endoscopic imaging data of the surgical site and/orpreoperative or real time image data from other imaging systems externalto the patient. Imaging system 102 outputs processed image data (e.g.,images of the surgical site, as well as relevant control and patientinformation) to the surgeon at the surgeon's console 104. In someaspects the processed image data is output to an optional externalmonitor visible to other operating room personnel or to one or morelocations remote from the operating room (e.g., a surgeon at anotherlocation may monitor the video; live feed video may be used fortraining; etc.).

The surgeon's console 104 includes, e.g., multiple DOF mechanical input(“master”) devices that allow the surgeon to manipulate the surgicalinstruments, guide tubes, and imaging system (“slave”) devices asdescribed herein. These input devices may in some aspects provide hapticfeedback from the instruments and instrument assembly components to thesurgeon. Console 104 also includes a stereoscopic video output displaypositioned such that images on the display are generally focused at adistance that corresponds to the surgeon's hands working behind/belowthe display screen. These aspects are discussed more fully in U.S. Pat.No. 6,671,581 which is incorporated by reference herein.

Control during insertion may be accomplished, for example, by thesurgeon virtually moving the image with one or both of the masters; sheuses the masters to move the image side to side and to pull it towardsherself, consequently commanding the imaging system and its associatedinstrument assembly (e.g., a flexible guide tube) to steer towards afixed center point on the output display and to advance inside thepatient. In one aspect the camera control is designed to give theimpression that the masters are fixed to the image so that the imagemoves in the same direction that the master handles are moved. Thisdesign causes the masters to be in the correct location to control theinstruments when the surgeon exits from camera control, and consequentlyit avoids the need to clutch (disengage), move, and declutch (engage)the masters back into position prior to beginning or resuming instrumentcontrol. In some aspects the master position may be made proportional tothe insertion velocity to avoid using a large master workspace.Alternatively, the surgeon may clutch and declutch the masters to use aratcheting action for insertion. In some aspects, insertion may becontrolled manually (e.g., by hand operated wheels), and automatedinsertion (e.g., servomotor driven rollers) is then done when the distalend of the surgical instrument assembly is near the surgical site.Preoperative or real time image data (e.g., MRI, X-ray) of the patient'sanatomical structures and spaces available for insertion trajectoriesmay be used to assist insertion.

The patient side support system 100 includes a floor-mounted base 108,or alternately a ceiling mounted base 110 as shown by the alternatelines. The base may be movable or fixed (e.g., to the floor, ceiling,wall, or other equipment such as an operating table).

Base 108 supports an arm assembly 101 that includes a passive,uncontrolled “setup” portion and an actively controlled “manipulator”portion. In one example, the setup portion includes two passiverotational “setup” joints 116 and 120, which allow manual positioning ofthe coupled setup links 118 and 122 when the joint brakes are released.A passive prismatic setup joint (not shown) between the arm assembly andthe base coupled to a link 114 may be used to allow for large verticaladjustments 112. Alternatively, some of these setup joints may beactively controlled, and more or fewer setup joints may be used invarious configurations. The setup joints and links allow a person toplace the robotic manipulator portion of the arm at various positionsand orientations in Cartesian x, y, z space. The remote center of motionis the location at which yaw, pitch, and roll axes intersect (i.e., thelocation at which the kinematic chain remains effectively stationarywhile joints move through their range of motion). As described in moredetail below, some of these actively controlled joints are roboticmanipulators that are associated with controlling DOFs of individualsurgical instruments, and others of these actively controlled joints areassociated with controlling DOFs of a single assembly of these roboticmanipulators. The active joints and links are movable by motors or otheractuators and receive movement control signals that are associated withmaster arm movements at surgeon's console 104.

As shown in FIGS. 1A and 1B, a manipulator assembly yaw joint 124 iscoupled between a distal end of setup link 122 and a proximal end of afirst manipulator link 126. Yaw joint 124 allows link 126 to move withreference to link 122 in a motion that may be arbitrarily defined as“yaw” around a manipulator assembly yaw axis 123. As shown, therotational axis of yaw joint 124 is aligned with a remote center ofmotion 146, which is generally the position at which an instrument (notshown) enters the patient (e.g., at the umbilicus for abdominalsurgery). In one embodiment, setup link 122 is rotatable along ahorizontal or x, y plane and yaw joint 124 is configured to allow firstmanipulator link 126 to rotate about yaw axis 123, such that the setuplink 122, yaw joint 124, and first manipulator link 126 provide aconstantly vertical yaw axis 123 for the robot arm assembly, asillustrated by the vertical dashed line from yaw joint 124 to remotecenter of motion 146.

A distal end of first manipulator link 126 is coupled to a proximal endof a second manipulator link 130, a distal end of second manipulatorlink 130 is coupled to a proximal end of a third manipulator link 134,and a distal end of third manipulator link 134 is coupled to a proximalend of a fourth manipulator link 138, by actively controlled rotationaljoints 128, 132, and 136, respectively. In one embodiment, links 130,134, and 138 are coupled together to act as a coupled motion mechanism.Coupled motion mechanisms are well known (e.g., such mechanisms areknown as parallel motion linkages when input and output link motions arekept parallel to each other). For example, if rotational joint 128 isactively rotated, then joints 132 and 136 also rotate so that link 138moves with a constant relationship to link 130. Therefore, it can beseen that the rotational axes of joints 128, 132, and 136 are parallel.When these axes are perpendicular to joint 124's rotational axis, links130, 134, and 138 move with reference to link 126 in a motion that maybe arbitrarily defined as “pitch” around a manipulator assembly pitchaxis 139. Since links 130, 134, and 138 move as a single assembly in oneembodiment, first manipulator link 126 may be considered an activeproximal manipulator link, and second through fourth manipulator links130, 134, and 138 may be considered collectively an active distalmanipulator link.

A manipulator assembly platform 140 is coupled to a distal end of fourthmanipulator link 138. Manipulator platform 140 includes a rotatable baseplate that supports manipulator assembly 142, which includes two or moresurgical instrument manipulators that are described in more detailbelow. The rotating base plate allows manipulator assembly 142 to rotateas a single unit with reference to platform 140 in a motion that may bearbitrarily defined as “roll” around a manipulator assembly roll axis141.

For minimally invasive surgery, the instruments must remainsubstantially stationary with respect to the location at which theyenter the patient's body, either at an incision or at a natural orifice,to avoid unnecessary tissue damage. Accordingly, the yaw and pitchmotions of the instrument shaft should be centered at a single locationon the manipulator assembly roll axis or instrument insertion axis thatstays relatively stationary in space. This location is referred to as aremote center of motion. For single port minimally invasive surgery, inwhich all instruments (including a camera instrument) must enter via asingle small incision (e.g., at the umbilicus) or natural orifice, allinstruments must move with reference to such a generally stationaryremote center of motion. Therefore, a remote center of motion formanipulator assembly 142 is defined by the intersection of manipulatorassembly yaw axis 123 and manipulator assembly pitch axis 139. Theconfiguration of links 130, 134, and 138, and of joints 128, 132, and136 is such that remote center of motion 146 is located distal ofmanipulator assembly 142 with sufficient distance to allow themanipulator assembly to move freely with respect to the patient. It canbe seen that manipulator assembly roll axis 141 also intersects remotecenter of motion 146.

As described in more detail below, a surgical instrument is mounted onand actuated by each surgical instrument manipulator of manipulatorassembly 142. The instruments are removably mounted so that variousinstruments may be interchangeably mounted on a particular instrumentmanipulator. In one aspect, one or more instrument manipulators may beconfigured to support and actuate a particular type of instrument, suchas a camera instrument. The shafts of the instruments extend distallyfrom the instrument manipulators. The shafts extend through a commoncannula placed at the entry port into the patient (e.g., through thebody wall or at a natural orifice). In one aspect, an entry guide ispositioned within the cannula, and each instrument shaft extends througha channel in the entry guide, so as to provide additional support forthe instrument shafts. The cannula is removably coupled to a cannulamount 150, which in one embodiment is coupled to the proximal end offourth manipulator link 138. In one implementation, the cannula mount150 is coupled to link 138 by a rotational joint that allows the mountto move between a stowed position adjacent link 138 and an operationalposition that holds the cannula in the correct position so that theremote center of motion 146 is located along the cannula. Duringoperation, the cannula mount is fixed in position relative to link 138according to one aspect. The instrument(s) may slide through an entryguide and cannula assembly mounted to a distal end of the cannula mount150, examples of which are explained in further detail below. Thevarious passive setup joints/links and active joints/links allowpositioning of the instrument manipulators to move the instruments andimaging system with a large range of motion when a patient is placed invarious positions on a movable table. In some embodiments, a cannulamount may be coupled to the proximal link or first manipulator link 126.

Certain setup and active joints and links in the manipulator arm may beomitted to reduce the robot's size and shape, or joints and links may beadded to increase degrees of freedom. It should be understood that themanipulator arm may include various combinations of links, passivejoints, and active joints (redundant DOFs may be provided) to achieve anecessary range of poses for surgery. Furthermore, various surgicalinstruments alone or instrument assemblies including guide tubes,multiple instruments, and/or multiple guide tubes, and instrumentscoupled to instrument manipulators (e.g., actuator assemblies) viavarious configurations (e.g., on a proximal face or a distal face of theinstrument transmission means or the instrument manipulator), areapplicable in aspects of the present disclosure.

FIGS. 2A-2C are diagrammatic perspective, side, and top views,respectively, of a patient side support cart 200 in a teleoperatedsurgical (telesurgical) system. The depicted cart 200 is an illustrativeembodiment of the general configuration described above with referenceto FIGS. 1A and 1B. A surgeon's console and a video system are not shownbut are applicable as described above with respect to FIGS. 1A and 1Band known telerobotic surgical system architectures (e.g., the da Vinci®Surgical System architecture). In this embodiment, cart 200 includes afloor-mounted base 208. The base may be movable or fixed (e.g., to thefloor, ceiling, wall, or other sufficiently rigid structure). Base 208supports support column 210, and an arm assembly 201 is coupled tosupport column 210. The arm assembly includes two passive rotationalsetup joints 216 and 220, which when their brakes are released allowmanual positioning of the coupled setup links 218 and 222. In thedepicted embodiment, setup links 218 and 222 move in a horizontal plane(parallel to the floor). The arm assembly is coupled to support column210 at a passive sliding setup joint 215 between the column 210 and avertical setup link 214. Joint 215 allows the manipulator arm to bevertically (perpendicular to the floor) adjusted. Accordingly, thepassive setup joints and links may be used to properly position a remotecenter of motion 246 with reference to the patient. Once the remotecenter of motion 246 is properly positioned, brakes at each of thejoints 215, 216, and 220 are set to prevent the setup portion of the armfrom moving.

In addition, the arm assembly includes active joints and links formanipulator arm configuration and movement, instrument manipulation, andinstrument insertion. The proximal end of a first manipulator link 226is coupled to the distal end of setup link 222 via an activelycontrolled rotational manipulator assembly yaw joint 224. As shown, therotational manipulator assembly yaw axis 223 of yaw joint 224 is alignedwith remote center of motion 246, as illustrated by the vertical dashedline from yaw joint 224 to remote center of motion 246.

The distal end of first manipulator link 226 is coupled to the proximalend of a second manipulator link 230, the distal end of secondmanipulator link 230 is coupled to the proximal end of a thirdmanipulator link 234, and the distal end of third manipulator link 234is coupled to the proximal end of a fourth manipulator link 238, byactively controlled rotational joints 228, 232, and 236, respectively.As described above, links 230, 234, and 238 function as a coupled motionmechanism, so that fourth manipulator link 238 automatically moves inconcert with second manipulator link 230 when link 230 is actuated. Inthe depicted embodiment, a mechanism similar to that disclosed in U.S.Pat. No. 7,594,912 (filed Sep. 30, 2004) is modified for use (see alsoe.g., U.S. patent application Ser. No. 11/611,849 (filed Dec. 15, 2006;U.S. Patent Application Pub. No. US 2007/0089557 A1)). Thus, firstmanipulator link 226 may be considered an active proximal link, andsecond through fourth links 230, 234, and 238 may be consideredcollectively an active distal link. In one embodiment, first link 226may include a compression spring counterbalance mechanism, as furtherdescribed below, to counterbalance forces from movement of the distallink about joint 228.

A manipulator assembly platform 240 is coupled to a distal end of fourthlink 238. Platform 240 includes a base plate 240 a upon which instrumentmanipulator assembly 242 is mounted. As shown in FIG. 2A, platform 240includes a “halo” ring inside which a disk-shaped base plate 240 arotates. Configurations other than the halo and disk may be used inother embodiments. Base plate 240 a's center of rotation is coincidentwith a manipulator assembly roll axis 241, as shown by the dashed linethat extends through the center of manipulator platform 240 and remotecenter of motion 246. Instruments 260 are mounted to the instrumentmanipulators of manipulator assembly 242 on a distal face of theinstrument manipulators in one embodiment.

As shown in FIGS. 2A and 2B, instrument manipulator assembly 242includes four instrument manipulators 242 a. Each instrument manipulatorsupports and actuates its associated instrument. In the depictedembodiment, one instrument manipulator 242 a is configured to actuate acamera instrument, and three instrument manipulators 242 a areconfigured to actuate various other interchangeable surgical instrumentsthat perform surgical and/or diagnostic work at the surgical site. Moreor fewer instrument manipulators may be used. In some operationalconfigurations, one or more manipulators may not have an associatedsurgical instrument during some or all of a surgical procedure. Theinstrument manipulators are disclosed in more detail below.

As mentioned above, a surgical instrument 260 is mounted to and actuatedby a respective instrument manipulator 242 a. In accordance with anaspect of the disclosure, each instrument is mounted to its associatedmanipulator at only the instrument's proximal end. It can be seen inFIG. 2A that this proximal end mounting feature keeps the instrumentmanipulator assembly 242 and support platform 240 as far from thepatient as possible, which for the given instrument geometries allowsthe actively controlled portion of the manipulator arm to move freelywithin a maximum range of motion with reference to the patient while notcolliding with the patient. The instruments 260 are mounted so thattheir shafts are clustered around manipulator assembly roll axis 241.Each shaft extends distally from the instrument's force transmissionmechanism, and all shafts extend through a single cannula placed at theport into the patient. The cannula is removably held in a fixed positionwith reference to base plate 240 a by a cannula mount 250, which iscoupled to fourth manipulator link 238. A single guide tube is insertedinto and freely rotates within the cannula, and each instrument shaftextends through an associated channel in the guide tube. Thelongitudinal axes of the cannula and guide tube are generally coincidentwith the roll axis 241. Therefore, the guide tube rotates within thecannula as base plate 240 a rotates. In some embodiments, a cannulamount may be operably coupled to first manipulator link 226.

Each instrument manipulator 242 a is movably coupled to an activetelescoping insertion mechanism 244 (FIG. 2B) operably coupled to thebase plate 240 a and may be used to insert and withdraw the surgicalinstrument(s). FIG. 2A illustrates instrument manipulators 242 aextended a distance toward a distal end of telescoping insertionmechanism 244 (see also FIGS. 3 and 4A), and FIG. 2B illustratesinstrument manipulators 242 retracted to a proximal end of telescopinginsertion mechanism 244 (see also FIG. 4B). Active joints 224, 228, 232,236 and manipulator platform 240 move in conjunction and/orindependently so that a surgical instrument (or assembly) moves aroundthe remote center of motion 246 at an entry port, such as a patient'sumbilicus, after the remote center of motion has been established by thepassive setup arms and joints.

As shown in FIG. 2A, cannula mount 250 is coupled to fourth link 238near the fourth manipulator link's proximal end. In other aspects,cannula mount 250 may be coupled to another section of the proximallink. As described above, cannula mount 250 is hinged, so that it canswing into a stowed position adjacent fourth link 238 and into anextended position (as shown) to support the cannula. During operation,cannula mount 250 is held in a fixed position relative to fourth link238 according to one aspect.

It can be seen that in the depicted embodiment first manipulator link226 is generally shaped as an inverted “L” in one example. A proximalleg of the “L” shaped link is coupled to link 226 at yaw joint 224, anda distal leg of the link is coupled to second manipulator link 238 atrotational joint 228. In this illustrative embodiment, the two legs aregenerally perpendicular, and the proximal leg of the first manipulatorlink rotates around a plane generally perpendicular to manipulatorassembly yaw axis 223 (e.g., a horizontal (x, y) plane if the yaw axisis vertical (z)). Accordingly, the distal leg extends generally parallelto the manipulator assembly yaw axis 223 (e.g., vertically (z) if theyaw axis is vertical). This shape allows manipulator links 230, 234, and238 to move underneath yaw joint 224, so that links 230, 234, and 238provide a manipulator assembly pitch axis 239 that intersects remotecenter of motion 246. Other configurations of first link 226 arepossible. For example, the proximal and distal legs of the first link226 may not be perpendicular to each other, the proximal leg may rotatein a plane different from a horizontal plane, or link 226 may have otherthan a general “L” shape, such as an arc shape.

It can be seen that a vertical yaw axis 223 allows link 226 to rotatesubstantially 360 degrees, as shown by dashed lines 249 (FIG. 2C). Inone instance the manipulator assembly yaw rotation may be continuous,and in another instance the manipulator assembly yaw rotation isapproximately ±180 degrees. In yet another instance, the manipulatorassembly yaw rotation may be approximately 660 degrees. The pitch axis239 may or may not be held constant during such yaw axis rotation. Sincethe instruments are inserted into the patient in a direction generallyaligned with manipulator assembly roll axis 241, the arm can be activelycontrolled to position and reposition the instrument insertion directionin any desired direction around the manipulator assembly yaw axis (see,e.g., FIGS. 25A-25C showing the instrument insertion direction toward apatient's head, and FIGS. 26A-26C showing the instrument insertiondirection toward a patient's feet). This capability may be significantlybeneficial during some surgeries. In certain abdominal surgeries inwhich the instruments are inserted via a single port positioned at theumbilicus, for example, the instruments may be positioned to access allfour quadrants of the abdomen without requiring that a new port beopened in the patient's body wall. Multi-quadrant access may be requiredfor, e.g., lymph node access throughout the abdomen. In contrast, theuse of a multi-port telerobotic surgical system may require thatadditional ports be made in the patient's body wall to more fully accessother abdominal quadrants.

Additionally, the manipulator may direct the instrument verticallydownwards and in a slightly pitched upwards configuration (see, e.g.,FIGS. 27A-27C showing the instrument insertion direction pitchedupwards). Thus, the angles of entry (both yaw and pitch about the remotecenter) for an instrument through a single entry port may be easilymanipulated and altered while also providing increased space around theentry port for patient safety and patient-side personnel to maneuver.

Furthermore, links 230, 234, and 238 in conjunction with active joints228, 232, and 236 may be used to easily manipulate the pitch angle ofentry of an instrument through the single entry port while creatingspace around the single entry port. For example, links 230, 234, and 238may be positioned to have a form factor “arcing away” from the patient.Such arcing away allows rotation of the manipulator arm about the yawaxis 223 that does not cause a collision of the manipulator arm with thepatient. Such arcing away also allows patient side personnel to easilyaccess the manipulator for exchanging instruments and to easily accessthe entry port for inserting and operating manual instruments (e.g.,manual laparoscopic instruments or retraction devices). In yet anotherexample, fourth link 238 has a form factor that arcs away from theremote center of motion and therefore the patient, allowing for greaterpatient safety. In other terms, the work envelope of the cluster ofinstrument manipulators 242 a may approximate a cone, with the tip ofthe cone at the remote center of motion 246 and the circular end of thecone at the proximal end of the instrument manipulators 242 a. Such awork envelope results in less interference between the patient and thesurgical robotic system, greater range of motion for the system allowingfor improved access to the surgical site, and improved access to thepatient by surgical staff.

Accordingly, the configuration and geometry of the manipulator armassembly 201 in conjunction with its large range of motion allow formulti-quadrant surgery through a single port. Through a single incision,the manipulator may direct the instrument in one direction and easilychange direction; e.g., working toward the head or pelvis of a patient(see, e.g., FIGS. 25A-25C) and then changing direction toward the pelvisor head of the patient (see, e.g., FIGS. 26A-26C), by moving themanipulator arm about the constantly vertical yaw axis.

This illustrative manipulator arm assembly is used, for example, forinstrument assemblies that are operated to move with reference to theremote center of motion. Certain setup and active joints and links inthe manipulator arm may be omitted, or joints and links may be added forincreased degrees of freedom. It should be understood that themanipulator arm may include various combinations of links, passive, andactive joints (redundant DOFs may be provided) to achieve a necessaryrange of poses for surgery. Furthermore, various surgical instrumentsalone or instrument assemblies including guide tubes, multipleinstruments, and/or multiple guide tubes, and instruments coupled toinstrument manipulators (actuator assemblies) via various configurations(e.g., on a proximal face or a distal face of the actuator assembly ortransmission mechanism), are applicable in the present disclosure.

Referring now to FIGS. 3, 4A-4B, 5A-1 through 5B-2, 5C-1 through 5C-4,and 8, aspects and embodiments of the instrument manipulator will bedescribed in greater detail with no intention of limiting the disclosureto these aspects and embodiments. FIG. 3 is a perspective view of anembodiment of a rotatable base plate 340 a of a manipulator assemblyplatform, a cluster of four instrument manipulators 342 mounted on thebase plate 340 a to form an instrument manipulator assembly, and fourinstruments 360 (the proximal portions are illustrated) each mounted tothe distal face of an associated instrument manipulator 342. Base plate340 a is rotatable about a manipulator assembly roll axis 341, asdescribed above. In one embodiment, roll axis 341 runs through thelongitudinal center of a cannula and entry guide assembly, through whichthe instruments 360 enter a patient's body. Roll axis 341 is alsosubstantially perpendicular to a substantially single plane of thedistal face of each instrument manipulator 342, and consequently to asubstantially single plane of the proximal face of an instrument mountedto the distal face of an instrument manipulator.

Each instrument manipulator 342 includes an insertion mechanism 344 thatis coupled to the base plate 340 a. FIG. 8 is a cutaway perspective viewthat illustrates an embodiment of the instrument insertion mechanism inmore detail. As shown in FIG. 8, an instrument insertion mechanism 844includes three links that slide linearly with reference to one anotherin a telescoping manner. Insertion mechanism 844 includes a carriage802, a carriage link 804, and a base link 808. As described in U.S.patent application Ser. No. 11/613,800 (filed Dec. 20, 2006; U.S. PatentApplication Pub. No. US 2007/0137371 A1), which is incorporated hereinby reference, carriage link 804 slides along base link 808, and carriage802 slides along carriage link 804. Carriage 802 and links 804,808 areinterconnected by a coupling loop 806 (which in one instance includesone or more flexible metal belts; alternatively, one or more cables maybe used). A lead screw 808 a in base link 808 drives a slider 808 b thatis coupled to a fixed location on coupling loop 806. Carriage 802 iscoupled to coupling loop 806 at a fixed location as well, so that asslider 808 b slides a particular distance x with reference to base link808, carriage 802 slides 2× with reference to base link 808. Variousother linear motion mechanisms (e.g., lead screw and carriage) may beused in alternate implementations of the insertion mechanism.

As shown in FIGS. 3 and 8, the proximal end of base link 808 is coupledto rotatable base plate 340 a, and carriage 802 is coupled to the outershell or inner frame of an instrument manipulator 342 (e.g., withininner frame aperture 542 i′ of FIGS. 5C-1 through 5C-3). A servomotor(not shown) drives lead screw 808 a, and as a result the instrumentmanipulator 342 moves proximally and distally with reference to baseplate 340 a in a direction generally parallel to roll axis 341. Since asurgical instrument 360 is coupled to the manipulator 342, the insertionmechanism 344 functions to insert and withdraw the instrument throughthe cannula towards and away from the surgical site (instrumentinsertion DOF). Flat electrically conductive flex cables (not shown)running adjacent the coupling loop may provide power, signals, andground to the instrument manipulator.

It can be seen that an advantage of the telescoping feature of theinsertion mechanism 344 is that it provides a larger range of motionwhen the instrument manipulator moves from its full proximal to its fulldistal position, with a smaller protruding insertion mechanism when themanipulator is at its full proximal position, than if only a singlestationary insertion stage piece is used (see e.g., FIGS. 4A (fulldistal position) and 4B (full proximal position)). The shortenedprotrusion prevents the insertion mechanism from interfering with thepatient during surgery and with operating room personnel, e.g., duringinstrument changing, when the instrument manipulator is at its proximalposition.

As further illustrated in FIG. 3, the telescopic insertion mechanisms344 are symmetrically mounted to the rotatable base plate 340 a in oneembodiment, and therefore the instrument manipulators 342 and mountedinstruments 360 are clustered symmetrically about the roll axis 341. Inone embodiment, instrument manipulators 342 and their associatedinstruments 360 are arranged around the roll axis in a generallypie-wedge layout, with the instrument shafts positioned close to themanipulator assembly roll axis 341. Thus, as the base plate rotatesabout the roll axis 341, the cluster of instrument manipulators 342 andmounted instruments 360 also rotates about the roll axis.

FIGS. 4A and 4B are perspective views that illustrate an instrumentmanipulator 442 at an extended and retracted position, respectively,along an insertion mechanism 444 mounted to a rotatable base plate 440a. As noted above, instrument manipulator 442 is able to extend andretract along a longitudinal axis of the insertion mechanism 444 betweenthe base plate 440 a and a free distal end 444 a of the insertionmechanism, as shown by the double-sided arrows adjacent to insertionmechanism 444. In this illustrative embodiment, instruments mountagainst the distal face 442 a of the instrument manipulator 442.

Distal face 442 a includes various actuation outputs that transferactuation forces to a mounted instrument. As shown in FIGS. 4A and 4B,such actuation outputs may include a grip output lever 442 b(controlling the grip motion of an instrument end effector), a joggleoutput gimbal 442 c (controlling the side-to-side motion and theup-and-down motion of a distal end parallel linkage (“joggle” or “elbow”mechanism)), a wrist output gimbal 442 d (controlling the yaw motion andthe pitch motion of an instrument end effector), and a roll output disk442 e (controlling the roll motion of an instrument). Details of suchoutputs, and the associated parts of the instrument force transmissionmechanism that receives such outputs, may be found in U.S. patentapplication Ser. No. 12/060,104 (filed Mar. 31, 2008; U.S. PatentApplication Pub. No. US 2009/0248040 A1), which is incorporated hereinby reference. Examples of the proximal ends of illustrative surgicalinstruments that may receive such inputs may be found in U.S. patentapplication Ser. No. 11/762,165, which is referenced above. Briefly, theside-to-side and up-and-down DOFs are provided by a distal end parallellinkage, the end effector yaw and end effector pitch DOFs are providedby a distal flexible wrist mechanism, the instrument roll DOF isprovided by rolling the instrument shaft while keeping the end effectorat an essentially constant position and pitch/yaw orientation, and theinstrument grip DOF is provided by two movable opposing end effectorjaws. Such DOFs are illustrative of more or fewer DOFs (e.g., in someimplementations a camera instrument omits instrument roll and gripDOFs).

In order to facilitate the mounting of an instrument against theinstrument manipulator's distal face, supports such as support hooks 442f are positioned on the instrument manipulator. In the depictedembodiment, the support hooks are stationary with reference to theinstrument manipulator's main housing, and the instrument manipulator'sdistal face moves proximally and distally to provide a secureinterconnection between the instrument manipulator and the instrument. Alatch mechanism 442 g is used to move the instrument manipulator'sdistal face toward an instrument's proximal face. In an alternativeembodiment, a latch mechanism may be used, to move the instrument'sproximal face toward the manipulator's distal face in order to engage ordisengage the manipulator outputs and instrument inputs.

FIGS. 5A-1 and 5B-1 are perspective views that illustrate an exemplaryarchitecture of an instrument manipulator 542. FIGS. 5A-2 and 5B-2 arecross-sectional views of FIGS. 5A-1 and 5B-1 along cut lines I-I andII-II, respectively. As shown, the manipulator includes an inner frame542 i movably coupled to an outer shell 542 h, for example by slidingjoints, rails, or the like. Inner frame 542 i moves distally andproximally with reference to outer shell 542 h as the result of theaction of latch mechanism 542 g.

Referring now to FIGS. 5A-1 through 5B-2, the operation of support hooks542 f and latch mechanism 542 g to mount an instrument (not shown) tothe instrument manipulator 542 is illustrated. As shown, a distal face542 a of the instrument manipulator 542 is substantially a single plane,and it is operably coupled to a proximal face of an instrument forcetransmission mechanism (e.g., proximal face 960′ of instrument 960 inFIGS. 9A-9B). Latch mechanism 542 g may include an actuation mechanism,such as a pulley and wire, to move the inner frame and outer shell ofthe instrument manipulator relative to one another, and to hold distalface 542 a against the instrument during operation.

In the depicted embodiment, instrument support hooks 542 f are rigidlymounted to instrument manipulator outer shell 542 h, and when latchmechanism 542 g is actuated, the distal face 542 a of the inner frame542 i of the instrument manipulator moves distally toward a distal endof support hooks 542 f and away from a proximal face 542 j of the outershell of the instrument manipulator. Thus, when an instrument forcetransmission mechanism is mounted on the support hooks 542 f, distalface 542 a of the instrument manipulator moves toward the proximal faceof the instrument transmission mechanism, which is restrained by supporthooks 542 f, in order to engage or otherwise operably interface theinstrument manipulator outputs with the instrument force transmissioninputs, as illustrated by arrow A1 in FIGS. 5A-1 and 5A-2. Asillustrated by this embodiment, actuator outputs of the manipulatorcompress against and interface with the proximal instrument face totransmit instrument actuator signals to the instrument. When the latch542 g is actuated in a reverse direction, distal face 542 a of theinstrument manipulator moves toward proximal face 542 j of theinstrument manipulator (i.e., away from distal ends of stationarysupport hooks 542 f) in order to disengage the instrument manipulatoroutputs from the instrument inputs, as illustrated by arrow A2 in FIGS.5B-1 and 5B-2. An advantage of the depicted embodiment is that when thelatch mechanism is activated, the actuator portions of the instrumentmanipulator move relative to a stationary instrument fixed in space onthe support hooks. The movement of the instrument manipulator'sactuators toward or away from the instrument minimizes unnecessary orunintended instrument motion during the latching or unlatching process.Accordingly, since the instrument does not move relative to the patientduring the instrument mounting process, potential damage to tissue isavoided, since the distal end of the instrument may still be inside thepatient.

In alternate embodiments, the support hooks 542 f may be retractedtoward proximal face 542 j to move a proximal face of an instrumenttoward the distal face 542 a of a stationary instrument manipulator inorder to engage the instrument manipulator outputs with the instrumentinputs, as shown by arrows B1 in FIGS. 5A-1 and 5A-2. When the latch isopened or reversely actuated, the process is reversed and the supporthooks 542 f move away from the distal face 542 a of the stationaryinstrument manipulator in order to disengage the instrument manipulatoroutputs with the instrument inputs, as illustrated by arrows B2 in FIGS.5B-1 and 5B-2.

FIGS. 5C-1 through 5C-4 illustrate different views of the instrumentmanipulator 542 without outer shell 542 h in order to reveal independentdrive modules for actuating the instrument manipulator outputs. Thedrive modules are mounted in modular form to inner frame 542 i of theinstrument manipulator, which moves along with the drive modules,relative to outer shell 542 h and support hooks 542 f of the instrumentmanipulator. When the latch is closed, the inner frame of the instrumentmanipulator moves toward the instrument a set distance, andspring-loaded module outputs engage instrument inputs through a steriledrape, as further described below. When the latch is opened, the processis reversed. Spring-loaded actuator drive module outputs provide arobust interface with the instrument force transmission mechanism inputsthrough the drape, as described in more detail below.

As illustrated in the depicted embodiment, instrument manipulator 542includes a grip actuator drive module 542 b′ for actuating a grip outputlever 542 b, a joggle actuator drive module 542 c′ for actuating ajoggle output gimbal 542 c, a wrist actuator drive module 542 d′ foractuating wrist output gimbal 542 d, and a roll actuator drive module542 e′ for actuating a roll output disc 542 e. Outputs 542 b, 542 c, 542d, and 542 e distally protrude from the distal face 542 a of instrumentmanipulator 542, as shown for example in FIG. 5C-4, and they are adaptedto engage with instrument force transmission mechanism inputs to actuateX-Y translation of the mounted instrument and grip, pitch, yaw, and rollend effector movements.

FIGS. 6A-6B are upper and lower perspective views of a grip actuatordrive module 642 b′ of an instrument manipulator. Grip actuator drivemodule 642 b′ includes a linear slide 602, a drive spring mechanism 604that includes a spring 606, and a grip drive output lever 642 b. Drivespring mechanism 604 is coupled to the inner frame 542 i of theinstrument manipulator. As the latch 542 g is actuated to engage aninstrument, the inner frame moves, and the grip drive module 642 b′moves along linear slide 602 until output lever 642 b contacts itsmating input on the instrument. This contact preloads the spring 606,thereby spring-loading the grip output 642 b against an instrument inputas the instrument is latched in place. The preloaded spring 606 thenensures that proper actuator drive output/input contact is maintainedduring operation, so that a clearance does not develop in theoutput/input contact, which would render precise kinematic controldifficult.

FIG. 7A is a bottom perspective view of a gimbal drive module 742 c/d′of the instrument manipulator that can be used to provide either thejoggle output gimbal controlling X-Y translation for the jogglemechanism of the instrument or the wrist output gimbal controlling pitchand yaw for the instrument end effector. In this embodiment, gimbaldrive module 742 c/d′ includes a linear slide 702, a drive springmechanism 704 including a spring 706, and an actuator output gimbal 742c/d on a gimbal pin 710. Drive spring mechanism 704 is coupled to theinner frame 542 i of the instrument manipulator. As latch 542 f isactuated to engage an instrument, the inner frame moves distally, andactuator drive module 742 c/d′ moves along linear slide 702 until outputgimbal 742 c/d contacts its mating input on the instrument. This contactpreloads the spring 706, thereby spring-loading the output gimbal 742c/d against an instrument input as the instrument is latched in place.As with the grip actuator drive module, the preloaded spring thenensures that proper actuator drive output/input contact is maintainedduring operation, so that a clearance does not develop in theoutput/input contact, which would render precise kinematic controldifficult. Gimbal drive module 742 c/d′ further includes two “dog bone”links 712, two ball screws 714, two motors 716, two Hall effect sensors718, and two rotary or linear motion encoders 720. Motors 716 driveassociated ball screws 714, which actuate dogbone links 712. Theproximal end of dogbone links 712 are coupled to linear slides 721,which move along axes parallel to ball screws 714. The distal end ofdogbone lines 712 are coupled to output gimbals 742 c/d, which eachrotate about two orthogonal axes perpendicular to the longitudinal axisthrough gimbal pin 710. In one aspect, the gimbals of the drive moduleshave two degrees of freedom but do not have orthogonal axes.

FIG. 7B is a bottom perspective view of a roll actuator drive module 742e′ of the instrument manipulator that can be used to provide roll outputdisc controlling roll movement of a mounted instrument. In thisembodiment, roll actuator drive module 742 e′ includes a motor 734 whichdrives a harmonic drive 736, which in turn drives spur gears 740. Thespur gears 740 rotate the roll output disc 742 e and thus drive the rollinput disc on the instrument. An encoder 732 is used to sense positionand commutate the motor 734. An absolute encoder 738 is coupled to theroll output disc 742 e and senses the absolute position of instrumentroll.

In one aspect, the system drive modules are operably independent andsufficiently isolated from one another, such that large forces appliedthrough one interface output are not transferred to the other interfaceoutputs. In other words, large forces through one interface output donot transfer to other interface outputs, and so do not affect theinstrument components actuated by the other interface outputs. In oneaspect, a drive module and its corresponding actuator outputs havesubstantially no unintended force input from another drive module and/orits corresponding actuator outputs. This feature improves instrumentoperation and consequently patient safety.

FIGS. 9A and 9B are perspective views of a proximal portion 960 a and adistal portion 960 b, respectively, of an instrument 960 configured tomount to the instrument manipulators of FIGS. 4A-4B and 5A-1 through5C-4. A proximal face 960′ of a transmission mechanism of instrument 960includes an instrument grip input lever 962 b that interfaces with gripoutput lever 542 b, an instrument joggle input gimbal 962 c thatinterfaces with joggle output gimbal 542 c, an instrument wrist inputgimbal 962 d that interfaces with wrist output gimbal 542 d, and aninstrument roll input disc 962 e that interfaces with roll output disc542 e. FIG. 9B illustrates an example of a distal end 960 b of aflexible surgical instrument 960 including a wrist 964, a jogglemechanism 966, and an end effector 968. In one embodiment, proximal face960′ of the transmission mechanism of instrument 960 has a substantiallysingle plane that operably interfaces with the distal face of theinstrument manipulator when the manipulator outputs and instrumentinputs are operably engaged. U.S. patent application Ser. No. 11/762,165entitled “Minimally Invasive Surgical System” by Larkin et al., which isincorporated herein by reference, and U.S. patent application Ser. No.11/762,154 entitled “Surgical Instrument With Parallel Motion Mechanism”by Cooper et al., which is incorporated herein by reference, disclosefurther details on applicable distal portions and proximal portions ofsurgical instruments, such as instrument 960.

In the illustrative aspect shown in FIGS. 9A and 9B, instrument 960includes a transmission portion at its proximal end, an elongatedinstrument body, one of various surgical end effectors 968, and asnake-like, two degree of freedom wrist mechanism 964 that couples endeffector 968 to the joggle mechanism 966 and the instrument body. As inthe da Vinci® Surgical Systems, in some aspects the transmission portionincludes disks that interface with electrical actuators (e.g.,servomotors) permanently mounted on a support arm so that instrumentsmay easily be changed. Other linkages such as matching gimbal plates andlevers may be used to transfer actuating forces at the mechanicalinterface. Mechanical mechanisms (e.g., gears, levers, gimbals) in thetransmission portion transfer the actuating forces from the disks tocables, wires, and/or cable, wire, and hypotube combinations that runthrough one or more channels in the instrument body (which may includeone or more articulated segments) to control wrist 964 and end effector970 movement. In some aspects, one or more disks and associatedmechanisms transfer actuating forces that roll the instrument bodyaround its longitudinal axis. The main segment of the instrument body isa substantially rigid single tube, although in some aspects it may beslightly resiliently flexible. This small flexibility allows a proximalbody segment proximal of a guide tube (i.e., outside the patient) to beslightly flexed so that several instrument bodies can be spaced moreclosely within a guide tube than their individual transmission segmenthousings would otherwise allow, like several cut flowers of equal lengthbeing placed in a small-necked vase. This flexing is minimal (e.g., lessthan or equal to about a 5-degree bend angle in one embodiment) and doesnot induce significant friction because the bend angle for the controlcables and hypotubes inside the instrument body is small. In otherwords, in one embodiment, an instrument shaft may distally exit a forcetransmission mechanism at a slight angle instead of orthogonal to adistal or proximal face of the force transmission mechanism. Theinstrument shaft may then bend slightly and continue straight to form aslight arc at a proximal section of the instrument shaft distallyexiting the force transmission mechanism. Thus, the instrument may havean instrument shaft with a proximal curved section proximal to the guidetube and a distal straight section. In one example, the instrument shaftmay be pitched between about zero degrees and about five degrees whendistally exiting the force transmission mechanism.

As shown in FIGS. 9A and 9B, instrument 960 includes a proximal bodysegment 968 (that extends through a guide tube in one example) and atleast one distal body segment or joggle mechanism 966 (that ispositioned beyond the guide tube's distal end in one example). Forexample, instrument 960 includes proximal body segment 968, jogglemechanism 966 that is coupled to proximal body segment 968 at a joint967, wrist mechanism 964 that is coupled to joggle mechanism 966 atanother joint 965 (the coupling may include another, short distal bodysegment), and an end effector 970. In some aspects the joggle mechanism966 and joints 965 and 967 function as a parallel motion mechanism inwhich the position of a reference frame at the distal end of themechanism may be changed with respect to a reference frame at theproximal end of the mechanism without changing the orientation of thedistal reference frame. Details of an applicable parallel motion orjoggle mechanism including related joints of an applicable instrument isfurther disclosed in U.S. patent application Ser. No. 11/762,165, whichhas been incorporated by reference.

FIG. 10 is a cross-sectional side view of an instrument manipulator 542operably coupled to an instrument 960 in accordance with aspects of thepresent disclosure. As shown in FIG. 10, actuator outputs 542 b-542 e ona distal face of the instrument manipulator 542 interface with actuatorinputs 962 b-962 e on a proximal face of the surgical instrument 960.

Since the instrument end effector is provided with seven degrees offreedom (instrument insertion, grip, 2-DOF wrist articulation, 2-DOFjoggle (wrist translation), and instrument roll) to facilitate surgery,the requirement for instrument actuation precision is high and ahigh-fidelity, low backlash interface between the instrument and theinstrument manipulator is desirable. The independently operated drivesystem modules of the instrument manipulator (e.g., modules 542 b′, 542c′, 542 d′, and 542 e′) allow the various drive trains to be coupled toa surgical instrument through an imprecisely manufactured drapesubstantially without performance comprise. As the drive system modulesare not coupled to one another and sufficiently isolated from oneanother, large forces applied through one interface output are nottransferred to the other interface outputs. In other words, large forcesthrough one interface output do not transfer to other interface outputs,and so do not affect the instrument components actuated by the otherinterface outputs. In one aspect, a drive module and its correspondingactuator outputs have substantially no unintended force input fromanother drive module and/or its corresponding actuator outputs. Thisfeature improves instrument operation and consequently patient safety.

In one aspect, mating disks may be used for force transmission featuresand actuating feature as in the da Vinci® Surgical System instrumentinterface. In another aspect, mating gimbal plates and levers are used.Various mechanical components (e.g., gears, levers, cables, pulleys,cable guides, gimbals, etc.) in the transmission mechanisms are used totransfer the mechanical force from the interface to the controlledelement. Each actuator mechanism includes at least one actuator (e.g.,servomotor (brushed or brushless)) that controls movement at the distalend of the associated instrument. For example, an actuator can be anelectric servomotor that controls a surgical instrument's end effectorgrip DOF. An instrument (including a guide probe as described herein) orguide tube (or, collectively, the instrument assembly) may be decoupledfrom the associated actuator mechanisms) and slid out. It may then bereplaced by another instrument or guide tube. In addition to themechanical interface there is an electronic interface between eachtransmission mechanism and actuator mechanism. This electronic interfaceallows data (e.g., instrument/guide tube type) to be transferred.Examples of the mechanical and electrical interfaces for the variousinstruments, guide tubes, and imaging systems, and also about steriledraping to preserve the sterile field, are discussed in U.S. Pat. No.6,866,671 (filed Aug. 13, 2001; Tierney et al.) and U.S. Pat. No.6,132,368 (filed Nov. 21, 1997; Cooper), both of which are incorporatedby reference herein.

Surgical instruments alone or assemblies including guide tubes, multipleinstruments, and/or multiple guide tubes, and instruments coupled toactuator assemblies via various configurations (e.g., on a proximal faceor a distal face of the instrument/actuator assembly), are applicable inthe present disclosure. Therefore, various surgical instruments may beutilized, each surgical instrument working independently of the otherand each having an end effector with at least six actively controlledDOFs in Cartesian space (i.e., surge, heave, sway, roll, pitch, yaw),via a single entry port in a patient.

The instrument shafts forming the end of these kinematic chainsdescribed above may be guided through cannulas and/or entry guides forinsertion into a patient, as further described below. Examples ofapplicable accessory clamps and accessories, such as cannulas, aredisclosed in pending U.S. application Ser. No. 11/240,087, filed Sep.30, 2005, the full disclosure of which is incorporated by referenceherein for all purposes.

Sterile Drape

Embodiments of the sterile drape will now be described in greaterdetail. Referring back to FIGS. 1A-1B and 2A-2C, sterile drape 1000 and2000 are shown covering a portion of the arm assembly 101 and 201,respectively, to shield non-sterile parts of the manipulator arm fromthe sterile field, and also to shield the arm and its various parts frommaterials from the surgical procedure (e.g., body fluids, etc.). In oneembodiment, the sterile drape includes a drape pocket configured toreceive an instrument manipulator of an instrument manipulator assembly.The drape pocket includes an exterior surface adjacent the sterilefield, and an interior surface adjacent the non-sterile instrumentmanipulator. The drape further includes a flexible membrane at a distalend of the drape pocket for interfacing between an output of theinstrument manipulator (e.g., the interface that transmits an actuatingforce to the associated instrument) and an input of the surgicalinstrument (e.g., the interface that receives the actuating force fromthe associated instrument manipulator), and a rotatable seal operablycoupled to a proximal opening of the drape pocket.

In another embodiment, the sterile drape includes a plurality of drapepockets, with each drape pocket including a plurality of flexiblemembranes at a distal end for interfacing between outputs of arespective instrument manipulator and inputs of a respective surgicalinstrument that control wrist, roll, grip, and translational motions ofthe surgical instrument. A rotatable seal, such as a labyrinth seal, maybe operably coupled to a proximal opening of the drape pockets to allowall drape pockets to rotate together as a group with reference to a moreproximal portion of the drape. In one example, a first portion of therotatable seal that includes the multiple drape pockets is coupled tothe rotatable base plate of the manipulator assembly platform and asecond portion of the rotatable seal is coupled to a frame of themanipulator assembly platform.

In yet another embodiment, a method of draping the manipulator arm of arobotic surgical system includes first positioning a distal end of asterile drape at the distal ends of the instrument manipulators, andthen draping each instrument manipulator with a drape pocket from thedistal end of the instrument manipulator to a proximal end of theinstrument manipulator. The rotatable seal of the sterile drape is thencoupled to a frame and a rotatable base plate of the manipulatorassembly platform. The remaining parts of the manipulator arm may thenbe draped as desired from a distal end of the manipulator arm to aproximal end of the manipulator arm. In this example, the manipulatorarm is draped from instrument manipulators to the yaw joint.

Advantageously, the configuration and geometry of the manipulator armand instrument manipulators with a sterile drape provide for a largerange of motion allowing for multi-quadrant surgery through a singleport (i.e., surgical access in all patient quadrants from the singleentry port), increased space around the patient and the entry port, andincreased patient safety, while also providing for a robustinstrument/manipulator interface, ease of instrument exchange, andmaintenance of a sterile environment, as described above.

Referring back to FIG. 10, the actuator outputs of the instrumentmanipulator 542 engage with the actuator inputs of the instrument 960through sterile drape 1000 or 2000. As noted above, in one embodiment,when latch 542 g is actuated, the inner frame of the instrumentmanipulator 542 moves toward the instrument 960 a set distance andspring-loaded module outputs 542 b-542 e engage instrument inputs 962b-962 e through drape 1000 or 2000. The independent actuator drivemodules 542 b′, 542 c′, 542 d′, and 542 e′ in the instrument manipulator542 provide actuator outputs 542 b, 542 c, 542 d, and 542 e,respectively, that engage instrument inputs 962 b, 962 c, 962 d, and 962e, respectively, through the sterile drape upon actuating latchmechanism 542 g, as described above.

Referring now to FIGS. 11A-11D in conjunction with FIG. 10, FIGS.11A-11B illustrate perspective views of a first drape portion 1100 a ofa sterile drape 1100 (FIG. 11D) in a retracted state and an extendedstate, respectively, and FIG. 11C illustrates a sectional view of drapeportion 1100 a mounted to a distal end of a rotatable base plate 1140 aof a manipulator platform in accordance with an embodiment of thepresent disclosure. Descriptions of sterile drapes 1000 and 2000 aboveare applicable with respect to sterile drape 1100. For example, steriledrape 1100 covers a portion of the manipulator arm assembly, and inparticular the instrument manipulators, to shield non-sterile parts ofthe manipulator arm from the sterile field. Furthermore, drape portion1100 a includes a plurality of drape pockets 1105 (e.g., fourwedge-shaped drape pockets 1105 a-1105 d are shown), each including anexterior surface configured to be adjacent the sterile field, and aninterior surface configured to be adjacent the non-sterile instrumentmanipulators. Each of the drape pockets 1105 further includes aplurality of flexible membranes 1102 at a distal end 1101 of the drapepockets 1105 for interfacing between outputs of the instrumentmanipulators and inputs of the surgical instruments. In one example,flexible membranes 1102 b, 1102 c, 1102 d, and 1102 e interface betweenthe instrument manipulator outputs 542 b, 542 c, 542 d, and 542 e andthe instrument inputs 962 b, 962 c, 962 d, 962 e to control instrumentgrip, translation, wrist, and roll motions, respectively, of thesurgical instrument. A flexible membrane provides a pocket extension1106 for the telescoping insertion mechanism of each instrumentmanipulator (e.g., insertion mechanism 444) along which the instrumentmanipulator may translate.

In one aspect, a distal end of pocket extension 1106 is attached to theinsertion mechanism such that the drape pocket extension 1106 moves withthe insertion mechanism and remains in a compact form away from thepatient to provide space and access to a surgical port. In one example,the distal end of pocket extension 1106 can be attached to the carriagelink 804 of an insertion mechanism 844 (FIG. 8) by any appropriateattachment means, such as clips, tabs, Velcro strips, and the like.

A rotatable seal 1108 operably couples proximal openings 1103 of thedrape pockets 1105 to the manipulator platform of the manipulator armassembly. In one example, the rotatable seal 1108 includes a rotatablelabyrinth seal having a roll cover portion 1108 a and a base combportion 1108 b rotatable within and relative to the roll cover portion1108 a. In one embodiment, base comb portion 1108 b includes a disc withribs 1104 that form a plurality of wedge-shaped “frames” with apertures,each of the frames sized to circumscribe an instrument manipulator. Inone embodiment, base comb portion 1108 b includes ribs 1104 formedninety degrees apart within the disc. Proximal ends of the drape pockets1105 are coupled to each of the frames of the base comb portion 1108 b.Accordingly, the ribbed base comb portion 1108 b aids in drapingindividual instrument manipulators which are closely clustered on therotatable base plate of the instrument manipulator and further aids inmaintaining the orientation and arrangement of the drape pockets 1105 asthe draped instrument manipulators move during a surgical procedure.

Roll cover portion 1108 a fixedly mounts to the frame of the manipulatorplatform and base comb portion 1108 b fixedly mounts to the rotatablebase plate 1140 a, such that when base plate 1140 a is rotated, the basecomb portion 1108 b also rotates in combination with the drapedinstrument manipulators while roll cover portion 1108 a is stationarybeing fixedly mounted to the manipulator platform frame.

FIGS. 11A and 11B illustrate the drape pockets 1105 in retracted andextended states, respectively, as the instrument manipulators retractand extend along their respective insertion axes. Although the fourdrape pockets 1105 are shown equally retracted and extended, the drapepockets may independently retract and extend as the instrumentmanipulators are independently and/or dependently controlled withrespect to one another.

It is also noted that base comb portion 1108 b may include variousnumber of ribs oriented at angles other than ninety degrees as long asspace is provided to fit an instrument manipulator through each of theframes of the base comb portion. In one example, the base comb portion1108 b may be comprised of ribs that divide a circular area into amultitude of segments that are each sized to enclose an instrumentmanipulator.

Sterile drape 1100 also allows for transitioning from the draping of theindividual instrument manipulators to the remaining parts of themanipulator arm assembly, as shown in FIG. 11D. The drape 1100 maycontinue from the rotatable seal 1108 (e.g., the roll cover portion 1108a) to blend into a larger second drape portion 1100 b designed to coverremaining portions (e.g., joints and links) of the manipulator arm asdesired, in one example continuously covering the manipulator arm to themanipulator assembly yaw joint (e.g., yaw joint 124, 224). Accordingly,the rotatable seal 1108 allows for the instrument manipulator cluster tofreely rotate relative to the rest of the manipulator arm assembly whilesubstantially the entire arm assembly remains draped, thereby preservingthe sterile environment of the surgical site.

In accordance with another embodiment, the sterile drape portion 1100 bincludes a cannula mounting arm pocket 1110 designed to drape aretractable cannula mounting arm as described in further detail below.In one embodiment, a movable cannula mount includes a base portioncoupled to the manipulator arm and a retractable portion movably coupledto the base portion. The retractable portion may be moved between aretracted position and a deployed position via a rotating joint so thatthe rectractable portion may be rotated upwards or folded toward thebase portion to create more space around the patient and/or to moreeasily don a drape over the cannula mount when draping the manipulatorarm. Other joints may be used to couple the retractable portion and thebase portion, including but not limited to a ball and socket joint or auniversal joint, a sliding joint to create a telescoping effect, and thelike, so that the retractable portion may be moved closer to the baseportion in order to reduce the overall form factor of the cannula mount.In another embodiment, the entire cannula mount may be internallytelescoping relative to the manipulator arm. Accordingly, the movablecannula mounting arm allows for the draping of a larger robot arm with arelatively smaller opening in the drape. The drape may be positionedover the retracted cannula mounting arm and then after being drapedwithin pocket 1110, the cannula mounting arm may be extended into anoperating position. According to one aspect, the cannula mounting arm isfixed in the operating position during operation of an instrument.

In one instance, drape pocket 1110 may include a reinforced drapesection 1111 that fits over a clamp (see, e.g., clamps 1754 in FIGS.19A-19B and 20A-20B, and clamp 2454 and receptacle 2456 in FIGS.24A-24D) on a distal end of the cannula mounting arm.

The drape 1100 a may further include a latch cover 1107 on the side ofindividual drape pockets 1105 to cover the individual latches 1342 g(FIG. 14A, 15, 16A, and 17A-17C) that may extend outside thecircumference of the instrument manipulator during use.

Advantageously, because of the distal face of the instrument manipulatorthat interfaces with an instrument, the spring-loaded and independentoutputs of the instrument manipulator, and advantageous sterile drape,instruments may be easily and robustly exchanged onto the instrumentmanipulator while maintaining a robust sterile environment during asurgical procedure. Furthermore, the sterile drape allows for thesurgical robotic system to be quickly and easily prepared while alsoproviding for improved range of motion (e.g., rotational motion) with asmall form factor, thereby reducing operating room preparation time andcosts.

Sterile Adapter

Another embodiment of a drape including a sterile adapter will now bedescribed in greater detail. FIG. 12 illustrates a perspective view of adrape portion 1200 a of an extended sterile drape including a sterileadapter 1250 in accordance with another embodiment of the presentdisclosure. Drape portion 1200 a may replace drape portion 1100 a inFIG. 11D, and is operably coupled to drape portion 1100 b by way of arotatable seal 1208 which is substantially similar to rotatable seal1108. Drape portion 1200 a includes a plurality of drape sleeves 1205coupled between rotatable seal 1208 and sterile adapter 1250. Drapeportion 1200 a further includes pocket extensions 1206 coupled to thesterile adapter 1250 for draping over insertion mechanisms of theinstrument manipulators.

Rotatable seal 1208 operably couples proximal openings 1203 of the drapesleeves 1205 to the manipulator platform of the manipulator armassembly. In one example, the rotatable seal 1208 includes a rotatablelabyrinth seal having a roll cover portion 1208 a and a base combportion 1208 b rotatable relative to the roll cover portion 1208 a. Inone embodiment, base comb portion 1208 b includes a disc with ribs 1204that form a plurality of wedge-shaped “frames” with apertures, each ofthe frames sized to circumscribe an instrument manipulator. In oneembodiment, base comb portion 1208 b includes ribs 1204 formed ninetydegrees apart within the disc. Proximal ends of the drape sleeves 1205are coupled to each of the frames of the base comb portion 1208 b.Accordingly, the ribbed base comb portion 1208 b aids in drapingindividual instrument manipulators which are closely clustered on therotatable base plate of the instrument manipulator and further aids inmaintaining the orientation and arrangement of the drape sleeves 1205 asthe draped instrument manipulators move during a surgical procedure.

Although FIG. 12 illustrates all the drape sleeves 1205 in extendedstates, for example as the instrument manipulators extend along theirrespective insertion mechanisms, it is noted that the drape sleeves mayindependently retract and extend as the instrument manipulators areindependently and/or dependently controlled with respect to one another.

It is also noted that base comb portion 1208 b may include variousnumber of ribs oriented at angles other than ninety degrees as long asspace is provided to fit an instrument manipulator through each of theframes of the base comb portion. In one example, the base comb portion1208 b may be comprised of ribs that divide a circular area into amultitude of segments that are sized to each enclose an instrumentmanipulator.

Roll cover portion 1208 a fixedly mounts to the frame of the manipulatorplatform (e.g., the manipulator halo) and base comb portion 1208 bfixedly mounts to the rotatable base plate 1140 a, such that when baseplate 1140 a is rotated, the base comb portion 1208 b also rotates incombination with the draped instrument manipulators. In one example,since the proximal end of drape sleeves 1205 are coupled to base combportion 1208 b, all the drape sleeves 1205 rotate together as a groupwith reference to a more proximal drape portion 1100 b.

FIGS. 13A and 13B illustrate a perspective view of an assembled sterileadapter 1250 and an exploded view of the sterile adapter 1250,respectively, in accordance with an embodiment of the presentdisclosure. Sterile adapter 1250 includes a boot 1252 having a boot wall1252 a and cylindrical apertures 1252 b that serve as passageways forposts on the instrument manipulator as will be further described below.A distal end of drape sleeves 1205 may be coupled to an exterior surfaceof boot wall 1252 a. Adapter 1250 further includes a pair of supports1258 that serve to properly align, position, and retain a surgicalinstrument on an underside of the sterile adapter for engagement withthe instrument manipulator on a top surface of the sterile adapter.Adapter 1250 further includes a flexible membrane interface 1254 thatinterfaces between outputs of a respective instrument manipulator andinputs of a respective surgical instrument for controlling wrist, roll,grip, and translational motions of the surgical instrument. In oneembodiment, membrane interface 1254 includes a grip actuator interface1254 b, a joggle actuator interface 1254 c, a wrist actuator interface1254 d, and a roll actuator interface 1254 e for interfacing withassociated instrument manipulator outputs.

In one embodiment, roll actuator interface 1254 e is designed to rotateand maintain a sterile barrier within the sterile adapter 1250. Asillustrated in FIG. 13C, in one aspect, the roll actuator interface 1254e includes a roll disc 1257 a having a slot or groove 1257 b around thecircumference of the disc that accepts a flat retaining plate 1254 f(FIG. 13B). The retaining plate 1254 f is attached to the flexiblemembrane interface 1254 and allows the roll disc to rotate whilemaintaining a sterile barrier for the sterile adapter and drape.

Membrane interface 1254 is positioned between boot 1252 and supports1258, and tubes 1256 couple boot 1252, membrane interface 1254, andsupports 1258 together. Tubes 1256 are aligned with boot apertures 1252b and membrane apertures 1254 b and a shaft portion of tubes 1256 arepositioned within the apertures. A tube lip 1256 a is retained withinboot aperture 1252 b and a tube end 1256 is fixedly coupled to support1258 such that tubes 1256 and therefore supports 1258 are movable acertain lengthwise distance of the tube shaft, as shown by the doublesided arrows in FIG. 13A.

Optionally, a grip actuator interface plate 1254 b′, a joggle actuatorinterface plate 1254 c′, and a wrist actuator interface plate 1254 d′may be coupled to an underside of the grip actuator interface 1254 b,the joggle actuator interface 1254 c, and the wrist actuator interface1254 d, respectively, for increased engagement and coupling withassociated instrument inputs.

FIGS. 14A and 14B illustrate a bottom perspective view and a bottom viewof an instrument manipulator 1300 in accordance with an embodiment ofthe present disclosure. In this illustrative embodiment, instrumentsmount against the distal face 1342 a of the instrument manipulator 1300.Distal face 1342 a includes various actuation outputs that transferactuation forces to a mounted instrument, similar to the instrumentmanipulators described above with respect to FIGS. 3-8. As shown inFIGS. 14A and 14B, such actuation outputs may include a grip outputlever 1342 b (controlling the grip motion of an instrument endeffector), a joggle output gimbal 1342 c (controlling the side-to-sidemotion and the up-and-down motion of a distal end parallel linkage(“joggle” or “elbow” mechanism)), a wrist output gimbal 1342 d(controlling the yaw motion and the pitch motion of an instrument endeffector), and a roll output disk 1342 e (controlling the roll motion ofan instrument). Independent actuator drive modules (similar to thosedescribed above with respect to modules 542 b′, 542 c′, 542 d′, and 542e′) in the instrument manipulator 1300 provide the actuator outputs 1342b, 1342 c, 1342 d, and 1342 e. In a similar manner, the actuator outputs1342 b-1342 e may be spring-loaded. Details of applicable outputs, andthe associated parts of the instrument force transmission mechanism thatreceives such outputs, may be found in U.S. patent application Ser. No.12/060,104 (filed Mar. 31, 2008; U.S. Patent Application Pub. No. US2009/0248040 A1), which is incorporated herein by reference. Examples ofthe proximal ends of illustrative surgical instruments that may receivesuch inputs may be found in U.S. patent application Ser. No. 11/762,165,which is referenced above. Briefly, the side-to-side and up-and-downDOFs are provided by a distal end parallel linkage, the end effector yawand end effector pitch DOFs are provided by a distal flexible wristmechanism, the instrument roll DOF is provided by rolling the instrumentshaft while keeping the end effector at an essentially constant positionand pitch/yaw orientation, and the instrument grip DOF is provided bytwo movable opposing end effector jaws. Such DOFs are illustrative ofmore or fewer DOFs (e.g., in some implementations a camera instrumentomits instrument roll and grip DOFs).

Instrument manipulator 1300 further includes a latch mechanism 1342 gfor engaging the actuator outputs of the instrument manipulator 1300with the actuator inputs of a mounted instrument through sterile adapter1250. In one embodiment, similar to the latch mechanism described above,when latch 1342 g is actuated, the inner frame 1342 i of the instrumentmanipulator 1300 moves a set distance relative to outer shell 1342 h andtowards a mounted instrument. Spring-loaded module outputs 1342 b-1342 eengage appropriate instrument inputs through the sterile adapter 1250,and in one example through the membrane interface 1254. A mountedinstrument is thus clamped between the upper surface of supports 1258and the spring loaded outputs through the membrane interface of thesterile adapter.

As noted above, the drape 1100 a may include a latch cover 1107 (FIG.11D) on the individual drape pockets 1105 to cover the individuallatches 1342 g that may extend outside the circumference of theinstrument manipulator during use. The latch handles are each able tofold inside the circumference of a corresponding instrument manipulatorto enable the rotatable seal of a drape to pass over the instrumentmanipulators.

Instrument manipulator 1300 further includes posts 1350 for operablycoupling the instrument manipulator 1300 to the sterile adapter 1250 aswill be further described below.

Referring now to FIGS. 15 and 16A-16E, the coupling of the instrumentmanipulator 1300 to the sterile adapter 1250 is illustrated anddescribed. FIG. 15 illustrates a bottom perspective view of theinstrument manipulator 1300 operably coupled to the sterile adapter 1250in accordance with an embodiment of the present disclosure. FIGS.16A-16E illustrate a sequence for coupling the instrument manipulator1300 and the sterile adapter 1250 in accordance with an embodiment ofthe present disclosure. As shown in FIG. 16A, posts 1350 are alignedwith tubes 1256 within boot apertures 1252 b. Then, as shown in FIG.16B, the free end of posts 1350 are positioned through tube 1256 untiltabs at the end of posts 1350 engage with associated support apertures,as shown in FIG. 16E. Thus, one end of posts 1350 are fixedly mounted tothe supports 1258. In one embodiment, supports 1258 include a slide 1258a having a keyhole aperture 1258 b, as illustrated in FIGS. 16C-1 and16C-2. Support 1258 is slid in a direction of arrow Ito allow the post1350 to pass to the end of the keyhole aperture 1258 b, as the sterileadapter is lifted into a final position as shown by arrow II. Thensupport 1258 is returned in a direction of arrow III by a biasing meanssuch that the narrow section of the keyhole aperture 1258 b locks into agroove 1350 a in the post 1350 (FIG. 16E).

After the supports 1258 of the sterile adapter have been attached to theposts on the instrument manipulator housing, the boot 1252 of thesterile adapter 1250 is attached to the distal face 1342 a of theinstrument manipulator 1300. In one embodiment, this attachment isaccomplished by protrusions on the inside walls of the boot thatregister in depressions on the sides of the inner frame 1342 i of theinstrument manipulator. Such an attachment allows the boot to stayattached to the inner frame as the inner frame is raised or lowered bythe latch 1342 g.

Referring now to FIGS. 17A-17C and 18A-18B, the coupling of a surgicalinstrument 1460 to the sterile adapter 1250 is illustrated anddescribed. FIGS. 17A-17C illustrate a sequence for coupling the surgicalinstrument 1460 to the sterile adapter 1250 in accordance with anembodiment of the present disclosure. As shown in FIG. 17A, theinstrument 1460 includes a force transmission mechanism 1460 a and ashaft 1460 b. A tip of shaft 1460 b is placed within an entry guide1500, which is freely rotatable within a cannula 1600. FIG. 17B showstabs (e.g., tabs 1462 of FIG. 18A) on the force transmission mechanism1460 a of instrument 1460 engaged with and aligned by a pair of supports1258, and FIG. 17C shows force transmission mechanism 1460 a beingfurther translated along a top surface of supports 1258.

FIGS. 18A and 18B illustrate an enlarged perspective view and side view,respectively, of the instrument 1460 and sterile adapter 1250 prior tofull translation of the force transmission mechanism 1460 a alongsupports 1258. Instrument 1460 is translated along supports 1258 until aretention mechanism is reached along the supports, which in one examplecan be a protrusion on an underside of tab 1462 that aligns and coupleswith an aperture on a top surface of support 1258. Latch 1342 g may thenbe actuated to engage the instrument manipulator outputs with theinstrument inputs through sterile adapter 1250. In one embodiment,supports 1258 are prevented from being removed from posts 1350 after aninstrument has been mounted. In one aspect, a protrusion on the supportmay engage with a depression on the side of the instrument forcetransmission mechanism housing to prevent the support from moving whilethe instrument has been mounted.

Entry Guide

Embodiments of an entry guide, cannula, and cannula mounting arm willnow be described in greater detail. As previously described, a surgicalinstrument is mounted on and actuated by each surgical instrumentmanipulator. The instruments are removably mounted so that variousinstruments may be interchangeably mounted on a particular manipulator.In one aspect, one or more manipulators may be configured to support andactuate a particular type of instrument, such as a camera instrument.The shafts of the instruments extend distally from the instrumentmanipulators. The shafts extend through a common cannula placed at theentry port into the patient (e.g., through the body wall, at a naturalorifice). The cannula is coupled to a cannula mounting arm which ismovably coupled to a manipulator arm. In one aspect, an entry guide ispositioned at least partially within the cannula, and each instrumentshaft extends through a channel in the entry guide, so as to provideadditional support for the instrument shafts.

FIGS. 19A and 19B illustrate perspective views of an embodiment of amovable and/or detachable cannula mount 1750 in a retracted position anda deployed position, respectively. Cannula mount 1750 includes anextension 1752 that is movably coupled to a link 1738 of the manipulatorarm, such as adjacent a proximal end of fourth manipulator link 138(FIGS. 1A and 1B). Cannula mount 1750 further includes a clamp 1754 on adistal end of extension 1752. In one implementation, extension 1752 iscoupled to link 1738 by a rotational joint 1753 that allows extension1752 to move between a stowed position adjacent link 1738 and anoperational position that holds the cannula in the correct position sothat the remote center of motion is located along the cannula. In oneimplementation, extension 1752 may be rotated upwards or folded towardlink 1738, as shown by arrow C, to create more space around the patientand/or to more easily don a drape over the cannula mount when drapingthe manipulator arm. Other joints may be used to couple the extension1752, including but not limited to a ball and socket joint or auniversal joint, a sliding joint to create a telescoping effect, and thelike, so that the extension may be moved closer to the link in order toreduce the overall form factor of the cannula mount and manipulator arm.In another embodiment, the extension 1752 may be internally telescopingrelative to the manipulator arm, or the extension 1752 may be detachablefrom and operably couplable to the link. During operation of thesurgical system, extension 1752 is maintained in an operating position.

FIGS. 20A and 20B illustrate perspective views of a cannula 1800 mountedto clamp 1754 of cannula mount 1750 as illustrated in FIGS. 19A-19B, andFIG. 21 illustrates a perspective view of free-standing cannula 1800. Inone embodiment, cannula 1800 includes a proximal portion 1804, which isremovably coupled to the clamp 1754, and a tube 1802 for passage ofinstrument shafts (as shown in FIG. 22). Once the cannula 1800 ismounted in clamp 1754, the clamp may keep cannula 1800 from rotating. Inone example, tube 1802 is comprised of stainless steel, and an interiorsurface of tube 1802 may be coated or lined with a lubricating oranti-friction material, although the cannula may be comprised of othermaterials, liners or no liners. Proximal portion 1804 may includeexterior ridges 1806, 1808 and an interior space for receipt of an entryguide with channels, as shown in FIGS. 22 and 23A-23B and as describedin more detail below. Examples of applicable accessory clamps andaccessories, such as cannulas, are disclosed in pending U.S. applicationSer. No. 11/240,087, filed Sep. 30, 2005, the full disclosure of whichis incorporated by reference herein for all purposes.

Referring now to FIGS. 22 and 23A-23B in accordance with embodiments ofthe present disclosure, FIG. 22 illustrates a cross-sectional view ofthe cannula 1800 of FIG. 21, and a cross-sectional view of a mountedentry guide tube 2200. Instrument manipulators 1942 are coupled to arotatable base plate 1940 of a manipulator platform, in one example bytelescoping insertion mechanisms 1942 a, and instruments 2160 aremounted to the instrument manipulators 1942 (e.g., on a distal orproximal face of the instrument manipulator). In one embodiment, thetelescoping insertion mechanisms 1942 a are symmetrically mounted to therotatable base plate 1940, and in one example are set apart 90 degreesfrom one another to provide for four instrument manipulators. Otherconfigurations and number of insertion mechanisms (and thereforeinstrument manipulators and instruments) are possible.

Thus, the instruments 2160 are mounted to the instrument manipulators1942 such that the instrument shafts 2160 b are clustered aroundmanipulator assembly roll axis 1941. Each shaft 2160 b extends distallyfrom the instrument's force transmission mechanism 2160 a, and allshafts extend through cannula 1800 placed at the port into the patient.The cannula 1800 is removably held in a fixed position with reference tobase plate 1940 by cannula mount 1750, which is coupled to fourthmanipulator link 138 in one embodiment. Entry guide tube 2200 isinserted into and freely rotates within cannula 1800, and eachinstrument shaft 2160 b extends through an associated channel 2204 inthe guide tube 2200. The central longitudinal axes of the cannula andguide tube are generally coincident with the roll axis 1941. Therefore,as the base plate 1940 rotates to rotate the instrument manipulators andrespective instrument shafts, the guide tube 2200 rotates within thecannula as base plate 1940 rotates. In one example, entry guide tube2200 is freely rotatable within the cannula about a central longitudinalaxis of the guide tube, which is aligned to a central longitudinal axisof the cannula, which in turn is aligned or runs parallel to the rollaxis 1941 of the manipulator platform. In other embodiments, the entryguide tube 2200 may be fixedly mounted to the cannula if such fixedsupport for the instrument shafts is desirable.

The cross-sectional view of entry guide tube 2200 is taken along a lineIII-III in FIGS. 23A and 23B, which illustrate a side view and a topview, respectively, of an entry guide tube 2200 having a coupling lip2202, a tube 2206, and channels 2204 a, 2204 b. Entry guide tube 2200includes lip 2202 on a proximal end of the tube 2206 to rotatably couplethe entry guide to the proximal portion 1804 of cannula 1800. In oneexample, lip 2202 couples between ridges (e.g., ridges 1806 and 1808 inFIG. 22) of the cannula. In other embodiments, the entry guide does notneed a coupling lip, as will be further described below.

Entry guide tube 2200 further includes channels 2204 a, 2204 b throughthe entry guide for passage of instrument shafts (e.g., instrumentshafts 2160 b in FIG. 22). In one aspect, one channel or passageway isprovided per instrument shaft and the channels may have differentgeometric shapes and sizes. As illustrated in FIGS. 23A and 23B, channel2204 a is of a different shape and size from channels 2204 b, and in oneexample, channel 2204 a is used to guide a camera instrument which has alarger and more rigid shaft, and channels 2204 b are used to guideinstrument shafts of typical instruments. Other shapes and sizes of thechannels are applicable, including but not limited to openings which areshaped as a circle, an oval, an ellipse, a triangle, a square, arectangle, and a polygon.

As the base plate rotates about the roll axis 1941, the cluster ofinstrument manipulators 1942 and instruments 2160 also rotate about theroll axis. As instrument shafts 2160 b rotate about roll axis 1941 whilein channels 2204 of the entry guide, an instrument shaft impingesagainst an interior surface of an entry guide channel, and at least onerotating instrument shaft drives entry guide tube 2200 to rotaterelative to and within cannula 1800, which is clamped and keptstationary by the clamp of a cannula mount; e.g., clamp 1754 of cannulamount 1750.

The instrument shafts may be inserted and retracted through the entryguide channels independently or in coordination with one another bymovement of respective insertion mechanisms 1942 a. The instruments 2160may rotate in a clockwise or counterclockwise direction about roll axis1941, and accordingly, entry guide tube 2200 may correspondingly rotatein a clockwise or counterclockwise direction about the roll axis. It isfurther noted that although four channels are illustrated in the entryguide and a plurality of instrument shafts are illustrated as passingthrough the entry guide and cannula, the entry guide and cannulaassembly may function within the surgical system with other numbers ofchannels and instrument/instrument assembly shafts running through theentry guide and cannula. For example, an entry guide tube with one ormore channels for running one or more instrument/instrument assemblyshafts through the entry guide and cannula is within the scope of thepresent disclosure. Furthermore, torque provided by the instrumentshafts to rotate the entry guide need not be symmetrically provided by aplurality of instrument shafts but may be provided asymmetrically andindependently, including the majority of the torque being provided by asingle instrument shaft.

In one embodiment, entry guide tube 2200 and cannula 1800 may eachinclude an electronic interface or a wireless interface, such as a radiofrequency identification (RFID) chip or tag, which includes identifyinginformation about the cannula and/or entry guide tube and allows for thesurgical system (e.g., read by the manipulator arm) to recognize theidentification of a particular entry guide and/or cannula. Metal rings,mechanical pins, and inductive sensing mechanisms may also be used toread identification data. This electronic or wireless interface allowsdata (e.g., entry guide tube/cannula type) to be transferred to thesurgical system. Details about mechanical and electrical interfaces forvarious instruments, guide tubes, and imaging systems, and also aboutsterile draping to preserve the sterile field, are discussed in U.S.Pat. No. 6,866,671 (Tierney et al.) and U.S. Pat. No. 6,132,368(Cooper), both of which are incorporated by reference, and which may besimilarly used with the entry guide and cannula.

It is further noted that in other embodiments, the entry guide tube maynot include a coupling lip. FIG. 24 illustrates a cross-sectional viewof an entry guide tube 2300 mounted to a cannula 2400. Entry guide tube2300 includes channels 2304 and is similar to entry guide tube 2200described above but does not include a coupling lip. Instead, entryguide tube 2300 is rotatably coupled to the proximal portion of thecannula by impingement force of the instrument shafts 2160 b against theinterior walls of the entry guide tube channels 2304. It is furthernoted that the cannula need not include exterior ridges at a proximalportion. It is further noted that in one aspect, the entry guide tubemay move rotatably and longitudinally along the cannula's longitudinalaxis or the roll axis, driven by the instrument shafts running throughthe entry guide tube.

Referring now to FIGS. 24A-24D, a different embodiment of a cannulamounting arm, clamp, and cannula are illustrated which may be used withan entry guide as described above. FIGS. 24A and 24B illustrateperspective views of an embodiment of a movable and/or detachablecannula mount 2450 in a retracted position and a deployed operatingposition, respectively. Cannula mount 2450 includes an extension 2452that is movably coupled to a link 2438 of the manipulator arm having aninstrument manipulator assembly platform 2440, such as adjacent aproximal end of fourth manipulator link 138 (FIGS. 1A and 1B). In oneimplementation, extension 2452 is coupled to link 2438 by a rotationaljoint 2453 that allows extension 2452 to move between a stowed positionadjacent link 2438 and an operational position that holds the cannula inthe correct position so that the remote center of motion is locatedalong the cannula. In one implementation, extension 2452 may be rotatedupwards or folded toward link 2438, as shown by arrow D, to create morespace around the patient and/or to more easily don a drape over thecannula mount when draping the manipulator arm. Other joints may be usedto couple the extension 2452, including but not limited to a ball andsocket joint or a universal joint, a sliding joint to create atelescoping effect, and the like, so that the extension may be movedcloser to the link in order to reduce the overall form factor of thecannula mount and manipulator arm. In another embodiment, the extension2452 may be internally telescoping relative to the manipulator arm, orthe extension 2452 may be detachable from and operably couplable to thelink.

Cannula mount 2450 further includes a clamp 2454 over a receptacle 2456on a distal end of extension 2452. FIG. 24C illustrates a perspectiveview of a cannula 2470 mountable to clamp 2454 and receptacle 2456 ofcannula mount 2450 as illustrated in FIG. 24D. In one embodiment,cannula 2470 includes a proximal portion 2474 having a boss 2476. Boss2476 includes a bottom hemispherical surface 2478 that is positionedwithin the mating receptacle 2456 (as shown by the arrow fromhemispherical surface 2478 to receptacle 2456). Boss 2476 furtherincludes a top surface 2479 which is engaged by clamp 2454 to lock theboss in position and therefore the cannula 2470 in a fixed positionrelative to cannula mount extension 2452. Clamp 2454 is actuated by alever 2480. Cannula 2470 further includes a tube 2472 for passage ofinstrument shafts (as shown in FIGS. 22 and 24). Once the cannula 2470is mounted by clamp 2454 and receptacle 2456, the clamp may keep cannula2470 from rotating. In one example, tube 2472 is comprised of stainlesssteel, and an interior surface of tube 2472 may be coated or lined witha lubricating or anti-friction material, although the cannula may becomprised of other materials, liners or no liners. Proximal portion 2474includes an interior space for receipt of an entry guide with channels,as shown in FIGS. 22, 23A-23B, and 24. Examples of applicable accessoryclamps and accessories, such as cannulas, are disclosed in pending U.S.application Ser. No. 11/240,087, filed Sep. 30, 2005, the fulldisclosure of which is incorporated by reference herein for allpurposes.

In one aspect, the entry guide and cannula assemblies described abovesupport insufflation and procedures requiring insufflation gas at thesurgical site. Further disclosure of insufflation through the entryguide and cannula assembly may be found in U.S. patent application Ser.No. 12/705,439, filed Feb. 12, 2010 and entitled “Entry Guide forMultiple Instruments in a Single Port System”, the full disclosure ofwhich is incorporated by reference herein for all purposes.

Advantageously, because the entry guide is dependently driven by theinstrument shaft(s), the need for a motor or other actuating mechanismto rotate the entry guide is eliminated. Furthermore, the entry guideallows for the removal of a bulky actuator mechanism near the patient orsurgical site. Thus, the entry guide and cannula assembly provide for anefficient and robust means to advantageously organize and supportmultiple instruments through a single port and reduce collisions betweeninstruments and other apparatus during a surgical procedure.

Single Port Surgical System Architecture

FIGS. 25A-25C, 26A-26C, and 27A-27C illustrate different views of asurgical system 2500 with an instrument manipulator assembly roll axisor instrument insertion axis pointed at different directions relative toa patient P. FIGS. 25A-25C illustrate a manipulator assembly roll axis2541 directed downward and toward patient P's head H. FIGS. 26A-26Cillustrate manipulator assembly roll axis 2541 directed downward andtoward patient P's feet F. FIGS. 27A-27C illustrate manipulator assemblyroll axis 2541 directed upward and toward patient P's head H.

Surgical system 2500 includes a setup link 2518 for locating a remotecenter of motion for the robotic surgical system, and a manipulator armassembly 2501 including an active proximal link 2526 and an activedistal link 2528, in which the proximal link 2526 is operably coupled tothe setup link 2518 by an active yaw joint 2524. A plurality ofinstrument manipulators 2542 form an instrument manipulator assemblywhich is rotatably coupled to a distal end of the distal link 2528. Inone embodiment, the plurality of instrument manipulators are coupled toa manipulator assembly platform 2540 by telescoping insertion mechanisms2544. The plurality of instrument manipulators 2542 are rotatable aboutthe roll axis 2541. In one embodiment, each of the plurality ofinstrument manipulators includes a distal face from which a plurality ofactuator outputs distally protrude, and a plurality of surgicalinstruments 2560 are coupled to the distal face of a correspondinginstrument manipulator. A cannula mount 2550 is movably coupled to thedistal link 2528, and a cannula and entry guide tube assembly 2552 iscoupled to the cannula mount 2550. In one embodiment, the cannula has acentral longitudinal axis substantially coincident with the roll axis2541. Each surgical instrument has a shaft passing through the entryguide tube and the cannula, such that rotation of at least oneinstrument shaft rotates the entry guide tube about the longitudinalaxis of the cannula.

A vertical manipulator assembly yaw axis 2523 at yaw joint 2524 allowsthe proximal link 2526 to rotate substantially 360 degrees or more aboutthe remote center of motion for the surgical system (see, e.g., FIG.2C). In one instance the manipulator assembly yaw rotation may becontinuous, and in another instance the manipulator assembly yawrotation is approximately ±180 degrees. In yet another instance, themanipulator assembly yaw rotation may be approximately 660 degrees.Since the instruments are inserted into the patient in a directiongenerally aligned with manipulator assembly roll axis 2541, themanipulator arm assembly 2501 can be actively controlled to position andreposition the instrument insertion direction in any desired directionaround the manipulator assembly yaw axis (see, e.g., FIGS. 25A-25Cshowing the instrument insertion direction toward a patient's head, andFIGS. 26A-26C showing the instrument insertion direction toward apatient's feet). This capability may be significantly beneficial duringsome surgeries. In certain abdominal surgeries in which the instrumentsare inserted via a single port positioned at the umbilicus (see, e.g.,FIGS. 25A-25C), for example, the instruments may be positioned to accessall four quadrants of the abdomen without requiring that a new port beopened in the patient's body wall. Multi-quadrant access may be requiredfor, e.g., lymph node access throughout the abdomen. In contrast, theuse of a multi-port telerobotic surgical system may require additionalports be made in the patient's body wall to more fully access otherabdominal quadrants.

Additionally, the manipulator may direct the instrument verticallydownwards and in a slightly pitched upwards configuration (see, e.g.,FIGS. 27A-27C showing the instrument insertion direction pitched upwardsnear a body orifice O). Thus, the angles of entry (both yaw and pitchabout the remote center) for an instrument through a single entry portmay be easily manipulated and altered while also providing increasedspace around the entry port for patient safety and patient-sidepersonnel to maneuver.

Furthermore, the links and active joints of the manipulator arm assembly2501 may be used to easily manipulate the pitch angle of entry of aninstrument through the single entry port while creating space around thesingle entry port. For example, the links of the arm assembly 2501 maybe positioned to have a form factor “arcing away” from the patient. Sucharcing away allows rotation of the manipulator arm about the yaw axis2523 that does not cause a collision of the manipulator arm with thepatient. Such arcing away also allows patient side personnel to easilyaccess the manipulator for exchanging instruments and to easily accessthe entry port for inserting and operating manual instruments (e.g.,manual laparoscopic instruments or retraction devices). In other terms,the work envelope of the cluster of instrument manipulators 2542 mayapproximate a cone, with the tip of the cone at the remote center ofmotion and the circular end of the cone at the proximal end of theinstrument manipulators 2542. Such a work envelope results in lessinterference between the patient and the surgical robotic system,greater range of motion for the system allowing for improved access tothe surgical site, and improved access to the patient by surgical staff.

Accordingly, the configuration and geometry of the manipulator armassembly 2501 in conjunction with its large range of motion allow formulti-quadrant surgery through a single port. Through a single incision,the manipulator may direct the instrument in one direction and easilychange direction; e.g., working toward the head a patient (see, e.g.,FIGS. 25A-25C) and then changing direction toward the pelvis of thepatient (see, e.g., FIGS. 26A-26C), by moving the manipulator arm aboutthe constantly vertical yaw axis 2523.

Referring now to FIG. 28, a diagrammatic view illustrates aspects of acentralized motion control and coordination system architecture forminimally invasive telesurgical systems that incorporate surgicalinstrument assemblies and components described herein. A motioncoordinator system 2802 receives master inputs 2804, sensor inputs 2806,and optimization inputs 2808.

Master inputs 2804 may include the surgeon's arm, wrist, hand, andfinger movements on the master control mechanisms. Inputs may also befrom other movements (e.g., finger, foot, knee, etc. pressing or movingbuttons, levers, switches, etc.) and commands (e.g., voice) that controlthe position and orientation of a particular component or that control atask-specific operation (e.g., energizing an electrocautery end effectoror laser, imaging system operation, and the like).

Sensor inputs 2806 may include position information from, e.g., measuredservomotor position or sensed bend information. U.S. patent applicationSer. No. 11/491,384 (Larkin, et al.) entitled “Robotic surgery systemincluding position sensors using fiber Bragg gratings”, incorporated byreference, describes the use of fiber Bragg gratings for positionsensing. Such bend sensors may be incorporated into the variousinstruments and imaging systems described herein to be used whendetermining position and orientation information for a component (e.g.,an end effector tip). Position and orientation information may also begenerated by one or more sensors (e.g., fluoroscopy, MRI, ultrasound,and the like) positioned outside of the patient, and which in real timesense changes in position and orientation of components inside thepatient.

As described below, the user interface has three coupled control modes:a mode for the instrument(s), a mode for the imaging system, and a modefor the manipulator arm configuration and/or roll axis control. A modefor the guide tube(s) may also be available. These coupled modes enablethe user to address the system as a whole rather than directlycontrolling a single portion. Therefore, the motion coordinator mustdetermine how to take advantage of the overall system kinematics (i.e.,the total DOFs of the system) in order to achieve certain goals. Forexample, one goal may be to optimize space around the patient or tominimize the form factor of the manipulator arm. Another goal may beoptimize instrument workspace for a particular configuration. Anothergoal may be to keep the imaging system's field of view centered betweentwo instruments. Therefore, optimization inputs 2808 may be high-levelcommands, or the inputs may include more detailed commands or sensoryinformation. An example of a high level command would be a command to anintelligent controller to optimize a workspace. An example of a moredetailed command would be for an imaging system to start or stopoptimizing its camera. An example of a sensor input would be a signalthat a workspace limit had been reached.

Motion coordinator 2802 outputs command signals to various actuatorcontrollers and actuators (e.g., servomotors) associated withmanipulators for the various telesurgical system arms. FIG. 28 depictsan example of output signals being sent to four instrument controllers2810, to an imaging system controller 2812, to a roll axis controller2814, and to a manipulator arm controller 2816, which then can sendcontrol signals to instrument actuators, active arm joints, rotationmechanisms of the manipulator platform, and active telescoping insertionmechanisms. Other numbers and combinations of controllers may be used.Control and feedback mechanisms and signals, such as positioninformation (e.g., from one or more wireless transmitters, RFID chips,etc.) and other data from a sensing system, are disclosed in U.S. patentapplication Ser. No. 11/762,196, which is incorporated by reference, andare applicable in the present disclosure.

Accordingly, in some aspects the surgeon who operates the telesurgicalsystem will simultaneously and automatically access at least the threecontrol modes identified above: an instrument control mode for movingthe instruments, an imaging system control mode for moving the imagingsystem, and a manipulator arm roll axis control mode for configuring thelinks of the manipulator arm into a certain form factor or relative toone another or the rotation of the manipulator platform, and also foractive movement about the outer yaw axis to enable multi-quadrantsurgery. A similar centralized architecture may be adapted to work withthe various other mechanism aspects described herein.

FIG. 29 is a diagrammatic view that illustrates aspects of a distributedmotion control and coordination system architecture for minimallyinvasive telesurgical systems that incorporate surgical instrumentassemblies and components described herein. In the illustrative aspectsshown in FIG. 29, control and transform processor 2902 exchangesinformation with two master arm optimizer/controllers 2904 a, 2904 b,with three surgical instrument optimizer/controllers 2906 a, 2906 b,2906 c, with an imaging system optimizer/controller 2908, and with aroll axis optimizer/controller 2910. Each optimizer/controller isassociated with a master or slave arm (which includes, e.g., the camera(imaging system) arm, the instrument arms, and the manipulator arm) inthe telesurgical system. Each of the optimizer/controllers receivesarm-specific optimization goals 2912 a-2912 g.

The double-headed arrows between control and transform processor 2902and the various optimizer/controllers represent the exchange ofFollowing Data associated with the optimizer/controller's arm. FollowingData includes the full Cartesian configuration of the entire arm,including base frame and distal tip frame. Control and transformprocessor 2902 routes the Following Data received from eachoptimizer/controller to all the optimizer/controllers so that eachoptimizer/controller has data about the current Cartesian configurationof all arms in the system. In addition, the optimizer/controller foreach arm receives optimization goals that are unique for the arm. Eacharm's optimizer/controller then uses the other arm positions as inputsand constraints as it pursues its optimization goals. In one aspect,each optimization controller uses an embedded local optimizer to pursueits optimization goals. The optimization module for each arm'soptimizer/controller can be independently turned on or off. For example,the optimization module for only the imaging system and the instrumentarm may be turned on.

The distributed control architecture provides more flexibility than thecentralized architecture, although with the potential for decreasedperformance. In this distributed architecture, however, the optimizationis local versus the global optimization that can be performed with thecentralized architecture, in which a single module is aware of the fullsystem's state.

Link Counterbalance

An embodiment of a counterbalancing mechanism in a proximal link willnow be described in greater detail with reference to FIGS. 30A-37C. FIG.30A illustrates a manipulator arm assembly 3001 which is substantiallysimilar to the arm assemblies described above, the features of which areapplicable with respect to assembly 3001 as well, and FIG. 30Billustrates a closer view of the counterbalancing proximal link of thearm assembly 3001. FIGS. 31-37C illustrate different views and aspectsof the counterbalancing system without the walls of a proximal linkhousing. In particular, FIG. 31 illustrates a perspective view of thecounterbalancing system, FIGS. 32A-36C illustrate views of an adjustmentpin, a linear guide, and a range of movement of the adjustment pin tomove an end plug relative to the linear guide, and FIGS. 37A-37Cillustrate detailed views from a distal end of the counterbalancingproximal link showing a rocker arm and set screws according to variousaspects of the present disclosure.

Referring now to FIGS. 30A-30B, manipulator arm assembly 3001 includes aproximal link 3026 which is operably couplable to a setup link by a yawjoint to form a manipulator assembly yaw axis 3023. Proximal link 3026is rotatably coupled to a distal link 3028 about a pivot axis 3070. Inone example, a motor 3073 may be controlled to pivot the distal link3028 about the pivot axis 3070. In one embodiment, distal link 3028includes an instrument manipulator assembly platform 3040 at a distalend of the distal link. A cannula mount 3050 is movably coupled to thedistal link 3028. In one embodiment, platform 3040 provides a rotatablebase plate on which instrument manipulators may be mounted and rotatedabout an instrument manipulator assembly roll axis 3041. Theintersection of yaw axis 3023, roll axis 3041, and an instrumentmanipulator assembly pitch axis 3039 form a remote center of motion 3046as has been previously described above.

Referring now in particular to FIGS. 30B and 31, counterbalancing link3026 includes a housing 3084 having a central longitudinal axis 3084 cthat runs between a housing proximal end or first end 3084 a and ahousing distal end or second end 3084 b. A compression spring 3080 isdisposed along the longitudinal axis 3084 c and has a spring proximalend or first end 3080 a and a spring distal end or second end 3080 b. Inone embodiment, the compression spring is comprised of silicon chromealloy, but may be comprised of other materials. A base 3092 is disposedat the first end of the housing and is coupled to the first end 3080 aof the compression spring 3080 by an alignment ring 3090 therebetween. Aplug 3074 is disposed at the second end of the housing and is coupled tothe second end 3080 b of the compression spring 3080. In one embodiment,alignment ring 3090 is fixedly coupled to first end 3080 a of thecompression spring 3080, and plug 3074 includes an external screw thread(e.g., screw thread 3074 a) onto which is screwed the spring second end3080 b.

A cable 3088 having a coupler 3071 at a first end of the cable iscoupled to a load from the distal link 3028, and a second end of thecable 3088 is operably coupled to the plug 3074. From the load bearingend of cable 3088 at coupler 3071, cable 3088 passes through a pluralityof pulleys 3076 and 3078 outside of housing 3084, and then through apulley 3094 at base 3092 prior to coupling to plug 3074. The load fromthe distal link 3028 pulls cable 3088 in directions E1 and E2 aboutpulley 3094 (FIG. 31), causing plug 3074 to compress spring 3080 in theE2 direction, which is set to counterbalance at least a portion of theload from the distal link about the pivot axis 3070.

In order to increase safety, cable 3088 may include redundant cableswhich are coupled to a cable tension equalizer 3082 that equalizestension across the redundant cables. A cable twister 3095 is optionallyused to operably couple the redundant cables to one another betweenpulley 3094 and coupler 3071. A plurality of cap screws 3075 may bedisposed between the cable tension equalizer 3082 and the plug 3074, andmay be used to adjust the force offset of the counterbalancing link. Inone embodiment, three cap screws 3075 couple the cable tension equalizer3082 and the plug 3074 with one cap screw bearing substantially all ofthe tension and the other two cap screws provided for redundancy andsafety purposes.

In one aspect, the portion of cable 3088 between pulley 3094 and plug3074 runs substantially along the central longitudinal axis 3084 c ofthe proximal link housing. In a further aspect, spring 3080 compressessubstantially along the central longitudinal axis 3084 c of the proximallink housing. Spring compression can however cause “bowing” ornon-linear compression of the spring along the longitudinal axis of thehousing, which can lead to scraping and contact of the spring againstthe inner surface of the proximal link housing. In order to reduce orsubstantially eliminate bowing, the orientation of spring 3080 at boththe first and second ends 3080 a and 3080 b may be adjusted inaccordance with various aspects of the present disclosure. Furthermore,in one embodiment, the housing includes a linear guide track 3096disposed parallel to the longitudinal axis of the housing 3084 c. Alinear guide 3086 that is movably or slidably joined to the linear guidetrack 3096 is fixedly coupled to a coil of the compression spring 3080.A linear guide 3072 that is also movably or slidably joined to thelinear guide track 3096 is operably coupled to the plug 3074. The linearguide track 3096 and linear guides 3086 and 3072 further reduce orsubstantially eliminate bowing of the compression spring 3080. It shouldbe noted that in some embodiments, the counterbalancing system may beoperated without linear guides and a linear guide track.

Referring now to adjustable alignment of the first end or proximal endof the compression spring, in one aspect, alignment ring 3090 is movablycoupled to base 3092 by a plurality of adjustment screws 3091, such thatmovement of the adjustment screws 3091 adjusts an orientation of thealignment ring 3090 and therefore an orientation of the first end ofspring 3080 a fixedly coupled to the alignment ring 3090. In oneexample, base 3092 is coupled to alignment ring 3090 by four adjustmentscrews 3091 set apart from one another in a square or rectangularconfiguration. Other geometric configurations of the screws arepossible. The adjustment screws 3091 are each movable in a directionsubstantially perpendicular to a planar top surface of the alignmentring 3090 (e.g., via a screwing action through base apertures havinginterior screw threads) such that the orientation of the alignment ringmay be adjusted at each point of contact with the adjustment screws.Accordingly, the orientation of the alignment ring 3090 and the fixedlycoupled first end 3080 a of spring 3080 may be adjusted at variouspoints along the alignment ring 3090. More or less adjustment screws3091 are within the scope of the present disclosure.

Referring now to FIGS. 32A-37C, detailed views from a distal end of thecounterbalancing proximal link without the walls of the link housing areillustrated. In particular, the figures illustrate views of anadjustment pin 3106, a rocker arm 3108, and a range of movement of theadjustment pin and the rocker arm to adjust an orientation of the endplug 3074 and the fixedly coupled second end 3080 b of spring 3080,according to various aspects of the present disclosure.

FIG. 32A illustrates a bottom perspective view of the counterbalancingsystem, and FIG. 32B illustrates a perspective view of a cross-sectionalong line IV-IV of FIGS. 31, 32A, and 37A. As noted above, a pluralityof cap screws 3075 a and 3075 b are disposed between and couple thecable tension equalizer 3082 and the plug 3074. Cap screw 3075 a bearsall the tension in this embodiment and the other two cap screws 3075 bare provided for redundancy and safety purposes. As further noted above,a distal end of spring 3080 is coupled to plug 3074 by screwing ontoexternal screw threads 3074 a of the plug 3074. Plug 3074 may optionallyinclude a plurality of grooves 3200 formed to lighten the weight of theplug. It is also noted that linear guide 3072 may be slidably coupled tolinear guide track 3096 by linear guide flanges 3072 a.

As can be seen in FIGS. 32A-32B, plug 3074 is coupled to linear guide3072 by adjustment pin 3106, a socket screw 3104 that runs through aninterior channel of the adjustment pin 3106, and a nut 3102 that screwsonto a free end 3104 a of socket screw 3104 to lock in place theposition of the adjustment pin 3106 and linear guide 3072 relative toone another. In one embodiment, the socket screw 3104 is a hex socketscrew. A head 3104 b of the socket screw 3104 opposite the free end 3104a is placed within an engaging trench 3105 of the adjustment pin 3106 tolock the head portion of the socket screw within the adjustment pin whenthe nut 3102 is fully engaged at the free end 3104 a of the socketscrew, thus locking the position of adjustment pin 3106 and linear guide3072 relative to one another.

Referring now to FIGS. 33-36C, adjusting movement of the adjustment pin3106 relative to linear guide 3072 is described in greater detail. FIG.33 illustrates a side view of the adjustment pin 3106 coupled to linearguide 3072, a circle 3114, and a circle center 3114 a about whichadjustment pin 3106 may pivot when the adjustment pin is not fullylocked in place relative to linear guide 3072. FIG. 34 illustrateslinear guide markings 3072 b and adjustment pin markings 3106 c when acentral longitudinal axis 3107 of adjustment pin 3106 is perpendicularto a central longitudinal axis 3097 of the linear guide 3072 or guidetrack 3096. The linear guide markings 3072 b and adjustment pin markings3106 c may be used by an adjuster of the counterbalancing system (and inparticular the plug orientation) to determine relative positions of theadjustment pin and linear guide. FIG. 35 illustrates a perspective viewof the adjustment pin 3106 including a pin shaft 3106 a and a pin head3106 b. As can be seen in FIGS. 33-35, pin head 3106 b has a curved topsurface that operably mates with a curved surface of the linear guide3072.

FIGS. 36A-36C illustrate side views of the adjustment pin 3106 andlinear guide 3072 and their respective central longitudinal axis 3107and 3097, respectively. FIG. 36A illustrates a perpendicular position ofcentral longitudinal axis 3107 of adjustment pin 3106 relative tocentral longitudinal axis 3097 of linear guide 3072, FIG. 36Billustrates a position in which the central longitudinal axis 3107 ofadjustment pin 3106 forms an obtuse angle with central longitudinal axis3097 of linear guide 3072, and FIG. 36C illustrates a position in whichthe central longitudinal axis 3107 of adjustment pin 3106 forms an acuteangel with central longitudinal axis 3097 of linear guide 3072.Accordingly, FIGS. 36A-36C illustrate the pivot movement of adjustmentpin 3106 relative to linear guide 3072, and thus the orientationadjustment that may be made to plug 3074 and the fixedly coupled secondend 3080 b of spring 3080.

FIG. 37A illustrates another bottom perspective view of thecounterbalancing system showing a rocker arm 3108 and set screws 3110,FIG. 37B illustrates FIG. 37A with the plug 3074 removed, and FIG. 37Cillustrates FIG. 37B with the rocker arm 3108 removed. Rocker arm 3108is coupled to adjustment pin 3106 at a free end of pin shaft 3106 a andset screws 3110 couple the rocker arm 3108 to plug 3074. A cross discpin 3112 clamps the rocker arm 3108 to adjustment pin 3106. Rocker arm3108 and coupled plug 3074 may pivot about the central longitudinal axis3107 of adjustment pin 3106 and may be adjusted by the movement of setscrews 3110 in a direction substantially perpendicular to longitudinalaxis 3107, for example by screwing action through rocker arm apertureshaving interior screw threads. Thus, the orientation of the plug 3074and fixedly coupled second end 3080 b of spring 3080 may be adjusted ateach point of contact with the set screws 3110. More or less adjustmentscrews 3110 are within the scope of the present disclosure. Accordingly,the orientation of the plug and therefore the second or distal end ofspring 3080 may be adjusted at various points by pivoting adjustment pin3106 and pivoting rocker arm 3108. In one aspect, adjustment pin 3106and rocker arm 3108 pivot about axes which are perpendicular to oneanother.

Furthermore, the counterbalancing link of the present disclosure allowsfor adjustment between the plug and the second end of the compressionspring to change the number of active coils that are compressible in thecompression spring. In one aspect, the second end of the compressionspring may be screwed further or less onto the exterior screw threads ofthe plug to change the number of active coils that are compressible.

Advantageously, as a motor pivots the distal link 3028 about the pivotaxis 3070 for increased and advantageous robot arm configuration andinstrument manipulation, the counterbalancing proximal link 3026 allowsfor easier movements of the distal link, and less torque required fromthe motor pivoting the distal link, while also providing for increasedsafety from any motor failure. In some embodiments, although thecounterbalancing mechanism of the proximal link was to totally fail, themotor pivoting the distal link may brake to hold the distal link inplace.

Embodiments described above illustrate but do not limit the disclosure.It should also be understood that numerous modifications and variationsare possible in accordance with the principles of the presentdisclosure. For example, in many aspects the devices described hereinare used as single-port devices; i.e., all components necessary tocomplete a surgical procedure enter the body via a single entry port. Insome aspects, however, multiple devices and ports may be used.

1.-34. (canceled)
 35. A surgical system drape comprising: a first drapeportion configured to receive a first manipulator of a surgical system;a second drape portion including a plurality of pockets, each pocket ofthe plurality of pockets being configured to receive a corresponding oneof a plurality of second manipulators of the surgical system; and arotatable seal coupling the second drape portion to the first drapeportion.
 36. The surgical system drape of claim 35, wherein at least oneof the plurality of pockets includes an interface between an output ofone of the plurality of second manipulators and an input of a surgicalinstrument.
 37. The surgical system drape of claim 36, the interfaceincluding a flexible membrane.
 38. The surgical system drape of claim36, the interface being at the distal end of the or each pocket.
 39. Thesurgical system drape of claim 35, wherein at least one pocket of theplurality of pockets is configured to allow one of the plurality ofsecond manipulators to move away from the first manipulator.
 40. Thesurgical system drape of claim 35 further comprising a pocket configuredto receive a cannula mount.
 41. The surgical system drape of claim 35,wherein the rotatable seal comprises a labyrinth seal.
 42. The surgicalsystem drape of claim 41, wherein the labyrinth seal comprises: a basecomb portion rotatably coupled to a roll cover portion, wherein the rollcover portion is configured to fixedly mount to a frame of the firstmanipulator, and wherein the base comb portion is configured to fixedlymount to a rotatable base of the first manipulator.
 43. The surgicalsystem drape of claim 35, wherein the rotatable seal is configured to becoupled to a frame of the first manipulator.
 44. The surgical systemdrape of claim 35, wherein an outer surface of each one of the pluralityof pockets is sterile.
 45. The surgical system drape of claim 35,wherein each pocket of the plurality of pockets comprises a distal face,each distal face being configured to allow an actuating force from acorresponding one of the plurality of second manipulators covered by thepocket to be transmitted through the pocket to an instrument mounted onthe corresponding one of the plurality of second manipulators.
 46. Thesurgical system drape of claim 45, wherein the distal face of eachpocket of the plurality of pockets comprises a flexible membrane, andthe flexible membrane allows the actuating force to be transmitted fromthe corresponding one of the plurality of second manipulators to theinstrument.
 47. The surgical system drape of claim 35, furthercomprising a drape pocket extension at a distal face of each of theplurality of pockets, wherein the drape pocket extension is configuredto receive a second manipulator mechanism.
 48. A method of draping asurgical system, the surgical system including a first manipulator and aplurality of second manipulators coupled to the first manipulator, themethod comprising: draping each second manipulator with a correspondingdrape pocket of a plurality of drape pockets of a surgical system drape;draping the first manipulator with a portion of the surgical systemdrape; and coupling a rotatable seal of the surgical system drape to thefirst manipulator, wherein the rotatable seal couples the portion of thesurgical system drape to the plurality of drape pockets.
 49. The methodof claim 48, wherein the rotatable seal comprises a labyrinth seal thatincludes a base comb portion rotatably coupled to a roll cover portion,and wherein coupling the rotatable seal of the surgical system drapeincludes fixedly mounting the roll cover portion to a frame of the firstmanipulator and coupling the base comb portion to a rotatable base ofthe first manipulator.
 50. The method of claim 49, wherein the base combportion includes a disc with ribs that form a plurality of apertures,each of the plurality of apertures being configured to circumscribe onesecond manipulator of the plurality of second manipulators, and whereinthe method further comprises passing the one second manipulator throughan aperture of the plurality of apertures prior to coupling therotatable seal to the first manipulator.
 51. The method of claim 48,further comprising draping a cannula mount with a pocket of the surgicalsystem drape.
 52. The method of claim 48, wherein the distal face of theone of the plurality of drape pockets comprises a flexible membrane. 53.A surgical system drape comprising: a first drape portion; a seconddrape portion including a plurality of pockets; and a rotatable sealcoupling the second drape portion to the first drape portion.
 54. Thesurgical system drape of claim 53, wherein each one of the plurality ofpockets includes an interface configured to be positioned between amanipulator received in the pocket and an instrument mounted on themanipulator.
 55. The surgical system drape of claim 54, wherein theinterface comprises a flexible membrane.
 56. The surgical system drapeof claim 54, wherein the interface is at the distal end of the pocket.57. The surgical system drape of claim 53, wherein the rotatable sealcomprises a labyrinth seal.
 58. The surgical system drape of claim 57,wherein the labyrinth seal comprises: a base comb portion rotatablycoupled to a roll cover portion.
 59. The surgical system drape of claim53, wherein an outer surface of each one of the plurality of pockets issterile.
 60. The surgical system drape of claim 53, further comprising adrape pocket extension at a distal face of each of the plurality ofpockets.
 61. The surgical system drape of claim 53, at least a portionof a pocket of the plurality of pockets being configured to allow anextension of a manipulator received in the pocket.